Showing papers in "Libyan Journal of Medicine in 2010"
TL;DR: Routine screening for intestinal parasites in HIV-positive patients is advocated and pathogenic intestinal parasites such as A. lumbricoides, hookworm, Giardia intestinalis, Entamoeba histolytica, Trichuris trichiura, and Taenia species among HIV-infected persons should not be neglected.
Abstract: This study was carried out to determine the presence of intestinal parasites and their correlation with CD4 + T-cell counts and demographics among human immunodeficiency virus (HIV)-positive patients in Benin City, Nigeria. Stool specimens from 2,000 HIV-positive patients and 500 controls (HIV-negative individuals) were examined for ova, cysts, or parasites, using standard procedures. In addition, patient’s blood samples were analyzed for CD4 counts by flow cytometry. An overall prevalence rate of 15.3% was observed among HIVpositive patients while 6.2% was noted among non-HIV subjects. HIV status was a significant (P<0.0001) risk factor for acquiring intestinal parasitic infections. Male gender, CD4 count <200 cell/ml, and diarrhea were significantly associated with an increased prevalence of intestinal parasitic infections among HIVpositive patients. The level of education, occupation, and source of water among HIV patients significantly (P<0.0001) affected the prevalence of intestinal parasitic infections. Ascaris lumbricoides was the most predominant parasite in both HIV-positive patients and controls. A CD4 count <200 cells/ml was significantly associated with only Isospora belli and Cryptosporidium infections. The presence of pathogenic intestinal parasites such as A. lumbricoides, hookworm, Giardia intestinalis, Entamoeba histolytica, Trichuris trichiura, and Taenia species among HIV-infected persons should not be neglected. Cryptosporidium species and I. belli were the opportunistic parasites observed in this study. Routine screening for intestinal parasites in HIV-positive patients is advocated. Keywords: intestinal parasites; HIV; CD4 count; Demographics; Benin City (Published: 29 October 2010) Citation: Libyan J Med 2010, 5 : 5506 - DOI: 10.3402/ljm.v5i0.5506
80 citations
TL;DR: CHROMagar Candida can easily identify three species of Candida on the basis of colonial color and morphology, and accurately differentiate between them i.e. Candida albicans, Candida tropicalis, and Candida krusei.
Abstract: Introduction: Identification of yeast isolated from clinical specimens to the species level has become increasingly important. Ever-increasing numbers of immuno-suppressed patients, a widening range of recognized pathogens, and the discovery of resistance to antifungal drugs are contributing factors to this necessity. Material and methods: A total of 487 yeast strains were studied for the primary isolation and presumptive identification, directly from clinical specimen. Efficacy of CHROMagar Candida has been evaluated with conventional methods including morphology on Corn meal-tween 80 agar and biochemical methods by using API 20 C AUX. Results: The result of this study shows that CHROMagar Candida can easily identify three species of Candida on the basis of colonial color and morphology, and accurately differentiate between them i.e. Candida albicans, Candida tropicalis, and Candida krusei. The specificity and sensitivity of CHROMagar Candida for C. albicans calculated as 99%, for C. tropicalis calculated as 98%, and C. krusei it is 100%. Conclusion: The data presented supports the use of CHROMagar Candida for the rapid identification of Candida species directly from clinical specimens in resource-limited settings, which could be very helpful in developing appropriate therapeutic strategy and management of patients. Keywords: CHROMagar Candida; resource-limited settings; presumptive identification (Published: 9 February 2010) Citation: Libyan J Med 2010, 5: 2144 - DOI: 10.3402/ljm.v5i0.2144
69 citations
TL;DR: There was a negative association between ABO blood groups A and O with DM type 2, with A andO group having less chances of diabetes, with large studies in other ethnic groups needed to confirm these results.
Abstract: Objective: So far no studies have been performed in Malaysia to look at association of diabetes mellitus (DM) with blood groups. We studied the association of ABO blood groups with DM type 2. Patients and methodology: It was a case control study conducted at Kepala Batas Hospital Batas, Penang, Malaysia in the year 2009, involving 70 patients with DM type 2 and 140 healthy controls. Ethical approval was obtained from Universiti Sains Malaysia. Blood samples were collected from the patients after consent. Samples were tested for ABO blood groups using ID-Card gel method. Results: Chi-square test results showed that there was an association between the ABO blood groups and DM type 2. It was found that A and O blood groups were negatively associated with DM type 2 (P<0.05) with higher percentage of A and O groups individuals were non-diabetic. No significant association was noted between DM type 2 and blood groups B (P=0.423) and AB (P=0.095). It was also noted that B blood group was distributed with highest percentage among patients with DM type 2 (53.71%) compared to controls (22.52%), but no statistical significance achieved. Conclusion: The results obtained suggest that there was a negative association between ABO blood groups A and O with DM type 2, with A and O group having less chances of diabetes. Large studies in other ethnic groups are needed to confirm these results. Keywords: blood group A; blood group O; diabetes mellitus (Published: 8 February 2010) Citation: Libyan J Med 2010, 5: 4847 - DOI: 10.3402/ljm.v5i0.4847
60 citations
TL;DR: H2O2 is a typical DNA damage-inducing agent and thus is a good model system to study the effects of oxidative stress and later decreased likely due to DNA repair mechanisms and antioxidant enzymes.
Abstract: Background: Hydrogen peroxide is a common reactive oxygen intermediate generated by various forms of oxidative stress. Aims: The aim of this study was to investigate the DNA damage capacity of H 2 O 2 in HepG2 cells. Methods: Cells were treated with H 2 O 2 at concentrations of 25 µM or 50 µM for 5 min, 30 min, 40 min, 1 h or 24 h in parallel. The extent of DNA damage was assessed by the comet assay. Results: Compared to the control, DNA damage by 25 µM and 50 µM H 2 O 2 increased significantly with increasing incubation time up to 1 h, but it was not increased at 24 h. Conclusions: Our Findings confirm that H 2 O 2 is a typical DNA damage inducing agent and thus is a good model system to study the effects of oxidative stress. DNA damage in HepG2 cells increased significantly with H 2 O 2 concentration and time of incubation but later decreased likely due to DNA repair mechanisms and antioxidant enzymes. Key words: DNA damage, Hydrogen peroxide, HepG2 cells, Comet assay. (Published: 13 January 2010) Citation: Libyan J Med 2010, 5: 4637 - DOI: 10.3402/ljm.v5i0.4
58 citations
TL;DR: In this paper, the efficacy of garlic (Allium sativum ) to reduce hepatotoxicity induced by lead nitrate was evaluated experimentally in male mice and the results indicated that garlic is a phytoantioxidant that can counteract the deleterious effects of lead nitrates.
Abstract: Lead is a blue-gray and highly toxic divalent metal that occurs naturally in the earth’s crust and is spread throughout the environment by various human activities. The efficacy of garlic ( Allium sativum ) to reduce hepatotoxicity induced by lead nitrate was evaluated experimentally in male mice. Oral treatment with lead nitrate at a dose of 50 mg/kg body weight daily for 40 days (1/45 of LD 50 ) induced a significant increase in the levels of hepatic aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, acid phosphatase, cholesterol, lipid peroxidation, and lead nitrate. In parallel, hepatic protein levels in lead-exposed mice were significantly depleted. Lead nitrate exposure also produced detrimental effects on the redox status of the liver indicated by a significant decline in the levels of liver antioxidants such as superoxide dismutase, catalase, and glutathione. After exposure to lead nitrate (50 mg/kg body weight for 10 days), the animals received aqueous garlic extract (250 mg/kg body weight and 500 mg/kg body weight) and ethanolic garlic extract (100 mg/kg body weight and 250 mg/kg body weight), and partially restored the deranged parameters significantly. Histological examination of the liver also revealed pathophysiological changes in lead nitrate-exposed group and treatment with garlic improved liver histology. Our data suggest that garlic is a phytoantioxidant that can counteract the deleterious effects of lead nitrate. Keywords: lead; Allium sativum; lipid peroxidation; marker enzymes; hepatotoxicity; metal estimation (Published: 7 January 2010) Citation: Libyan J Med 2010, 5: 4621 - DOI: 10.4176/091107
44 citations
TL;DR: Evidence is found in The Canon that Avicenna challenged Galen's concept of pain and used terminology that is remarkably similar to that used in the McGill Pain Questionnaire.
Abstract: Ibn Sina (Latin name - Avicenna, 980-1037) is a famous Muslim physician who wrote The Canon of Medicine. Pain-related writings within The Canon were identified and analysed and compared to Galen and Modern Pain Theory. We found evidence in The Canon that Avicenna challenged Galen's concept of pain. Galen insisted that injuries (breach of continuity) were the only cause of pain. In contrast, Avicenna suggested that the true cause of pain was a change of the physical condition (temperament change) of the organ whether there was an injury present or not. Avicenna extended Galen's descriptions of 4 to 15 types of pain and used a terminology that is remarkably similar to that used in the McGill Pain Questionnaire.
37 citations
TL;DR: The Libyan Pharmaceutical List of Essential Medicines does not include several essential medicines recommended by the WHO in the WMLEM 2009, which may have serious public health implications for management of some infectious diseases, particularly, tuberculosis and HIV.
Abstract: Aim and Objectives: To examine the concordance of the Libyan Pharmaceutical List of Essential Medicines (LPLEM) with the World Health Organization Model List of Essential Medicines 2009 (WMLEM 2009). Methods: The concordance between generic medicines listed in the WMLEM 2009 (standard reference list) and the LPLEM 2006 (comparator list) was evaluated. Results: The total number of Basic Essential Medicines (BEMs) listed on the WMLEM 2009 was 347. The total number of generic medicines listed on the LPLEM was 584. Although the LPLEM has more listed medicines, only 270 (77.6%) of BEMs from the WMLEM were listed as available. However, 25 of the 77 missing medicines were deemed to have appropriate alternatives. A total of 52 medicines from the WMLEM 2009 were therefore missing from the LPLEM. Discrepancies compared to the WMLEM 2009 were identified in 15 out of 29 therapeutic sections. The highest discrepancy rate from the WMLEM 2009 was in the anti-infective section (35 missing medicines). Missing BEMs were noted in many subclassifications of the antiinfective medicines section, but omissions were particularly prevalent in the antibacterial medicines subsection (11 missing medicines). Antituberculosis medications had the highest discrepancy rate for antibacterial BEMs with one-third of the single medicines recommended by the WHO in the WMLEM 2009 not listed on the LPLEM. Of the 314 additional medicines on the LPLEM, 18 were deemed to be irrational non-essential medicines. Conclusion: The LPLEM does not include several essential medicines recommended by the WHO in the WMLEM 2009. These discrepancies may have serious public health implications for management of some infectious diseases, particularly, tuberculosis and HIV. Keywords: essential medicines; medicine selection; national medicines policy; pharmaceuticals policy; formulary list (Published: 2 December 2010) Citation: Libyan J Med 2010, 5: 5403 - DOI: 10.3402/ljm.v5i0.5403
34 citations
TL;DR: Results suggest that the protective effects of phloroacetophenone are due to reduction of oxidative damage induced by CCl4 resulting from the antioxidant properties of THA.
Abstract: Background: This study investigated the hepatoprotective effect and antioxidant properties of phloroacetophenone (2',4',6'-trihydroxyacetophenone - THA), an acetophenone derived from the plant Myrcia multiflora. Material & Method: The free radical scavenging activity in vitro and induction of oxidative hepatic damage by carbon tetrachloride (CCl 4 ) (0.5 ml/kg, i.p.) were tested in male Swiss mice (25±5 g). Results: This compound exhibited in vitro antioxidant effects on FeCl 2 -ascorbate-induced lipid peroxidation (LPO) in mouse liver homogenate, scavenging hydroxyl and superoxide radicals, and 2,2-diphenyl-1- picrylhydrazyl. The in vivo assays showed that THA significantly (p<0.01) prevented the increases of hepatic LPO as measured by the levels of thiobarbituric acid-reactive substances, mitochondrial swelling. It also protected hepatocytes against protein carbonylation and oxidative DNA damage. Consistent with these observations, THA pre-treatment normalized the activities of antioxidant enzymes, such as catalase, glutathione peroxidase, and superoxide dismutase, and increased the levels of reduced glutathione (GSH) in CCl 4 -treated mice. In addition, THA treatment significantly prevented the elevation of serum enzymatic activities of alanine amino transferase, aspartate amino transferase, and lactate dehydrogenase, as well as histological alterations induced by CCl 4 . Silymarin (SIL) (24 mg/kg), a known hepatoprotective drug used for comparison, led to a significant decrease (p<0.01) in activities of theses enzymes in way very similar to that observed in pre-treatment with THA. Conclusion: These results suggest that the protective effects are due to reduction of oxidative damage induced by CCl 4 resulting from the antioxidant properties of THA. Keywords: antioxidant; hepatoprotective; 2',4',6'-trihydroxyacetophenone; Myrcia multiflora; CCl 4 ; Silymarin (Published: 8 June 2010) Citation: Libyan J Med 2010, 5: 4891 - DOI: 10.3402/ljm.v5i0.4891
29 citations
TL;DR: In the light of the high prevalence of EDS among depressed patients and its undesirable consequences, it is suggested that daytime sleepiness be evaluated in depressed patients.
Abstract: Background: Excessive daytime sleepiness (EDS) has been reported among depressed patients in many populations. Many depressed patients seek medical attention partly to deal with EDS, but this sleep disorder is often overlooked in clinical practice. Objectives: The objectives of this study were to determine the prevalence of EDS among depressed patients and determine its relationship with the severity of depression. Methods: Sixty-seven patients diagnosed with depressive episode took part in the study. The severity of depression was rated using the 17-item Hamilton Depression Rating Scale (HDRS). EDS was evaluated using the Epworth Sleepiness Scale (ESS). Results: The mean ESS score was 9.2 (SD=2.8). EDS, defined as an ESS score]10, was present in 44.8% of the depressed patients. The mean score on the HDRS was 14.8 (SD=3.6), representing the mild-moderate depression range. ESS scores correlated highly and positively (r=0.69, p=0.000) with scores on the HDRS. Conclusion: In the light of the high prevalence of EDS among depressed patients and its undesirable consequences, it is suggested that daytime sleepiness be evaluated in depressed patients. Keywords: excessive daytime sleepiness; depression; Epworth Sleepiness Scale; hypersomnia (Published: 7 January 2010) Citation: Libyan J Med 2010, 5: 4626 - DOI: 10.4176/091024
27 citations
TL;DR: Improving patient selection for DC may be expected to further improve the outcome following the procedure in severely brain-injured patients.
Abstract: Background: Decompressive craniectomy (DC) is often performed as an empirical lifesaving measure to protect the injured brain from the damaging effects of propagating oedema and intracranial hypertension. However, there are no clearly defined indications or specified guidelines for patient selection for the procedure. Aims: To evaluate outcome determinants and factors important in patient selection for the procedure. Methods: We reviewed the literature on DC, including single case reports and reported case series, to identify factors affecting outcome following the procedure, as well as its pitfalls and associated complications. Results: Glasgow coma score of 8 and above, age less than 50 years and early intervention were found to be among the most significant determinants of prognosis. Conclusion: Improving patient selection for DC may be expected to further improve the outcome following the procedure in severely brain-injured patients. Keywords: decompressive craniectomy; indications; intracranial hypertension; outcome; patient selection (Published: 6 January 2010) Citation: Libyan J Med 2010, 5: 4620 - DOI: 10.4176/091104
27 citations
TL;DR: Foreign bodies should be suspected and ruled out in all cases of penetrating injuries of hands and need to be removed after proper localization by imaging.
Abstract: Introduction: Penetrating hand injuries are common and improper assessment can result in missed foreign bodies. These bodies can result in a wide range of complications. Aim: The aim of our study was to study the profile of patients reporting with missed foreign bodies in the hand. Materials and methods: All the cases treated in the Department of Surgery, Sheri Kashmir Institute of Medical Sciences (medical college), Kashmir, for missed foreign bodies in hands from June 2003 to May 2009 were studied retrospectively. Results: A total of 61 cases with missed foreign bodies of different nature were treated over the period of six years. Wooden splinters were the most common foreign bodies missed. Preoperative localization was accomplished with plain radiographs and ultrasonograms. Most of the cases were treated on outpatient basis. Conclusions: Foreign bodies should be suspected and ruled out in all cases of penetrating injuries of hands. Missed foreign bodies need to be removed after proper localization by imaging. Keywords: foreign body; radio-opaque; splinter; exploration; complication (Published: 12 April 2010) Citation: Libyan J Med 2010, 5: 5083 - DOI: 10.3402/ljm.v5i0.5083
TL;DR: Renal volume is higher in the left than the right kidney in hypertension patients of both sexes and female hypertensive patients have smaller kidney size compared to males, and positive correlation between renal volume, BSA and BMI is shown.
Abstract: Background and aims: To determine renal volume in adult patients with essential hypertension and correlate it with age, sex, body mass index (BMI), body surface area (BSA) and duration of hypertension Patients and methods: A total of 150 patients (75 males, 75 females) with essential hypertension and normal renal status were evaluated sonographically in this prospective study Fifty healthy individuals (25 males, 25 females) without hypertension were also evaluated as control Renal volume was then calculated from the kidney’s length, width and anterio-posterior diameter using the formula L x W x AP x 0523 Results: The range of renal volume obtained was 5165-20502 cm 3 , with a mean of 11406±92978 cm 3 for the left kidney and 4737-17750 cm 3 with a mean of 10614±2542 cm 3 for the right kidney The mean volumes of the right and left kidneys in males (11298±2556 cm 3 and 12311±3249 cm 3 , respectively), were significantly higher than in females (9931±2307 cm 3 and 10501±2377 cm 3 , respectively) Renal volume correlated significantly with BSA and BMI, but decreased with age The renal volume showed no correlation with duration of hypertension Conclusion: Renal volume is higher in the left than the right kidney in hypertensive patients of both sexes and female hypertensive patients have smaller kidney size compared to males The study also shows that volume of both kidneys decreases with age and positive correlation between renal volume, BSA and BMI However, there is no correlation between renal size and duration of hypertension Keywords: essential hypertension; renal volume; ultrasonography (Published: 25 January 2010) Citation: Libyan J Med 2010, 5: 4848 - DOI: 103402/ljmv5i04848
TL;DR: Elevated serum IgG levels with hypergammaglobulinemia are commonly found in patients with advanced CLD, and the differentiation of such cases from AIH is important in order to avoid misdiagnosis and confusion with AIH.
Abstract: Background: Hypergammaglobulinemia is frequently observed in patients with chronic liver disease (CLD) of different causes. On the other hand, elevated levels of serum immunoglobulin G (IgG) are the best diagnostic marker for autoimmune hepatitis (AIH). Thus, the ability to distinguish AIH patients from patients with other liver disease, especially patients with advanced liver cirrhosis, is important since most AIH patients will a have favorable treatment response if diagnosed properly. Objective: We conducted this study to evaluate the significance of elevated IgG levels in patients with nonautoimmune CLD and to compare these IgG levels with those in patients with AIH upon diagnosis. Setting and study population: The serum IgG levels in 27 patients with AIH determined at the time of diagnosis were compared to the serum IgG levels in 27 patients with other CLDs of variable severity at the King Abdul Aziz University Hospital in Jeddah, Saudi Arabia. Severity of the disease was evaluated in all patients. Results: We found that the patients in the CLD group with decompensated cirrhosis had significantly higher serum IgG levels compared to the compensated CLD patients (pB0.02). In addition, the AIH patients had significantly higher serum IgG levels than the non-autoimmune hepatitis CLD patients and the decompensated cirrhosis patients in the CLD group (pB0.001 and pB0.044, respectively). Most patients with elevated serum IgG of the AIH group (67%) and the CLD group (75%) had significant hypergammaglobulinemia, not just isolated elevated IgG levels. Conclusion: Elevated serum IgG levels with hypergammaglobulinemia are commonly found in patients with advanced CLD. The differentiation of such cases from AIH is important in order to avoid misdiagnosis and confusion with AIH. Keywords: decompensated cirrhosis; hypergammaglobulinemia; chronic hepatitis C; compensated cirrhosis (Published: 25 January 2010) Citation: Libyan J Med 2010, 5: 4857 - DOI: 10.3402/ljm.v5i0.4857
TL;DR: In this article, the efficacy of garlic (Allium sativum) to reduce hepatotoxicity induced by lead nitrate was evaluated experimentally in male mice and the results indicated that garlic is a phytoantioxidant that can counteract the deleterious effects of lead nitrates.
Abstract: Lead is a blue–gray and highly toxic divalent metal that occurs naturally in the earth's crust and is spread throughout the environment by various human activities. The efficacy of garlic (Allium sativum) to reduce hepatotoxicity induced by lead nitrate was evaluated experimentally in male mice. Oral treatment with lead nitrate at a dose of 50 mg/kg body weight daily for 40 days (1/45 of LD50) induced a significant increase in the levels of hepatic aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, acid phosphatase, cholesterol, lipid peroxidation, and lead nitrate. In parallel, hepatic protein levels in lead-exposed mice were significantly depleted. Lead nitrate exposure also produced detrimental effects on the redox status of the liver indicated by a significant decline in the levels of liver antioxidants such as superoxide dismutase, catalase, and glutathione. After exposure to lead nitrate (50 mg/kg body weight for 10 days), the animals received aqueous garlic extract (250 mg/kg body weight and 500 mg/kg body weight) and ethanolic garlic extract (100 mg/kg body weight and 250 mg/kg body weight), and partially restored the deranged parameters significantly. Histological examination of the liver also revealed pathophysiological changes in lead nitrate-exposed group and treatment with garlic improved liver histology. Our data suggest that garlic is a phytoantioxidant that can counteract the deleterious effects of lead nitrate.
TL;DR: VEGF could not be well correlated with stage of tumour and hence may be a poor prognostic parameter of state of malignancy of colonic carcinoma, however, it provides further evidence for the role of VEGF in the carcinogenesis of CRC.
Abstract: Background: Colorectal carcinoma (CRC) is the seventh-most common malignancy and is the main cause of death in Iraq. The incidence of this cancer has increased sharply after the invasion of Iraq in 2003. Aim: To estimate immunohistochemical expression of vascular endothelial growth factor (VEGF) in CRC in relation to other parameters, such as grade and stage of tumour. Methods: Formalin fixed, paraffin-embedded blocks from 52 patients (27 male and 25 female) with CRC were included in this study. A group of 22 patients with non-cancerous colonic tissues were included as a control group. Avidin-biotin complex method was employed for immunohistochemical detection of VEGF. Results: VEGF immuno-expression was positive in 51.9% of CRC, while it was 18.2% in the normal colonic tissue (p<0.05). VEGF immunostaining was positively correlated with grade of colonic malignancy (p<0.05). Conclusion: These findings provide further evidence for the role of VEGF in the carcinogenesis of CRC. However, VEGF could not be well correlated with stage of tumour and hence may be a poor prognostic parameter of state of malignancy of colonic carcinoma. Keywords: colorectal carcinoma; VEGF; immunohistochemistry (Published: 8 April 2010) Citation: Libyan J Med 2010, 5: 5059 - DOI: 10.3402/ljm.v5i0.5059
TL;DR: There is an urgent need for the proper training of microbiology laboratory technicians in standard antimicrobial susceptibility procedures and the implementation of quality control programs in microbiology laboratories of Libyan hospitals to overcome misidentification of nosocomial S. aureus as MRSA.
Abstract: Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial (hospital-acquired) pathogen of exceptional concern. It is responsible for life-threatening infections in both the hospital and the community. Aims: To determine the frequency of MRSA misidentification in hospitals in Tripoli, Libya using current testing methods. Methods: One hundred and seventy S. aureus isolates previously identified as MRSA were obtained from three hospitals in Tripoli. All isolates were reidentified by culturing on mannitol salt agar, API 20 Staph System and retested for resistance to methicillin using the cefoxitin disk diffusion susceptibility test and PBP2a. D-tests and vancomycin E-tests (Van-E-tests) were also performed for vancomycin-resistant isolates. Results: Of the 170 isolates examined, 86 (51%) were confirmed as MRSA (i.e. 49% were misidentified as MRSA). Fifteen (17%) of the confirmed MRSA strains exhibited inducible clindamycin resistance. Of the 86 confirmed MRSA isolates, 13 (15%) were resistant to mupirocin, 53 (62%) were resistant to ciprofloxacin, 41 (48%) were resistant to trimethoprim-sulfamethoxazole, and none were resistant to linezolid. Although discdiffusion testing indicated that 23 (27%) of the isolates were resistant to vancomycin, none of the isolates were vancomycin-resistant by Van-E-test. Conclusions: Misidentification of nosocomial S. aureus as MRSA is a serious problem in Libyan hospitals. There is an urgent need for the proper training of microbiology laboratory technicians in standard antimicrobial susceptibility procedures and the implementation of quality control programs in microbiology laboratories of Libyan hospitals. Keywords: MRSA misidentification; clindamycin resistance; E-test; vancomycin resistance (Published: 3 November 2010) Citation: Libyan J Med 2010, 5 : 5230 - DOI: 10.3402/ljm.v5i0.5230
TL;DR: The immunoregulatory mechanisms underlying the beneficial effects of SIT are discussed with the ultimate aim to improve its treatment efficacy.
Abstract: Allergic asthma is a disease characterized by persistent allergen-driven airway inflammation, remodeling, and airway hyperresponsiveness. CD4 + T-cells, especially T-helper type 2 cells, play a critical role in orchestrating the disease process through the release of the cytokines IL-4, IL-5, and IL-13. Allergen-specific immunotherapy (SIT) is currently the only treatment with a long-term effect via modifying the natural course of allergy by interfering with the underlying immunological mechanisms. However, although SIT is effective in allergic rhinitis and insect venom allergy, in allergic asthma it seldom results in complete alleviation of the symptoms. Improvement of SIT is needed to enhance its efficacy in asthmatic patients. Herein, the immunoregulatory mechanisms underlying the beneficial effects of SIT are discussed with the ultimate aim to improve its treatment efficacy. Keywords: allergic asthma; immunotherapy; dendritic cell; regulatory T cells; Th2 lymphocytes; hyperresponsiveness; eosinophilia; IgE; IL-10 (Published: 21 June 2010) Citation: Libyan J Med 2010, 5: 5303 - DOI: 10.3402/ljm.v5i0.5303
TL;DR: High levels of cholesterol in stones and dyslipidemia associated with mixed as well as cholesterol gallstones suggest an etiological association and efforts to reduce dietary fat among the Libyan population may lead to decreased cholesterol and mixed gallstones.
Abstract: Gallstone disease is one of the major surgical problems in the Libyan population; it is probably related to diet, especially excessive consumption of meat. The study was conducted to determine the composition of gallstones and their possible etiology in a Libyan population. The chemical composition of gallstones from 41 patients (six males and 35 females) was analyzed. The stones were classified into cholesterol, pigment, and mixed stones (MS). Cholesterol stones (CS) showed a significantly higher cholesterol content than pigment stones (PS) (p=0.0085) though not significantly higher than MS. Their phospholipid content and inorganic phosphates were higher than in the other types of stones and oxalate content was significantly elevated in comparison with MS (p=0.0471). In MS, the cholesterol, bile acids, and bilirubin were intermediate between cholesterol and PS, whereas triglycerides were significantly more than PS (p=0.0004). Bilirubin (0.0001) and bile acids (p=0.0009) were significantly higher than CS (p=0.0001). However, they contained the lowest amounts of sodium, potassium, magnesium, and oxalate. In PS, bilirubin (p=0.0001) was significantly higher than both groups. Bile acid content was significantly higher than CS (p=0.0001) but not significantly more than MS. They showed the highest values of calcium, sodium, potassium, magnesium, and chlorides compared to the other types of stones. High levels of cholesterol in stones and dyslipidemia associated with mixed as well as cholesterol gallstones suggest an etiological association and efforts to reduce dietary fat among the Libyan population may lead to decreased cholesterol and mixed gallstones. Keywords: gallstones; chemical composition; Libya; cholesterol (Published: 7 January 2010) Citation: Libyan J Med 2010, 5: 4627 - DOI: 10.4176/091020
TL;DR: A customer-friendly facility concept that emphasizes reception, physician interaction, and cordiality shall add value in the Libyan National Health System.
Abstract: Introduction: The Libyan National Health System (LNHS) is debated for the paradox of its performance versus impact. It has poor performance, but the national health statistics are good and competitive. There are concerted efforts to manage health care services and to regain the lost trust. A primary health care (PHC) system that focuses on preventive and promotive care is the core focus of LNHS efforts. Objectives: To assess patient satisfaction with quality of PHC assessed in terms of (a) customer profile, (b) patient satisfaction, and (c) health care-seeking behavior. Methodology: A sample of nine health centers and seven polyclinics from various locations in Benghazi, Libya were selected for gathering information by structured face-to-face interviews. A total of 310 beneficiaries were interviewed by using an Arabic translation of the Charleston Psychiatric Outpatient Satisfaction Scale. Results: The beneficiaries appear to be quite satisfied with the quality of services. Geographical zone, marital status of beneficiary, and type of facility are satisfaction-related factors. There are preferences for facilities located within the City Centre over those located elsewhere. There is also an interaction effect of the geographical zone and the type of facility in creating differences in satisfaction. Conclusions: A customer-friendly facility concept that emphasizes reception, physician interaction, and cordiality shall add value. Polyclinics require more attention as does the Al Slawy area. A few utility services might also be considered. Keywords: exit interviews; Health For All by All; geographic zone; administrative and environmental factors; health-seeking behavior; interaction effect; type and location of facility; place of residence (Published: 21 October 2010) Citation: Libyan J Med 2010, 5: 4873 - DOI: 10.3402/ljm.v5i0.4873
TL;DR: The fluorescent Y body test is shown to be a reliable, simple, and cost-effective technique for gender identification in the immediate postmortem period up to one month.
Abstract: Objective: This study was carried out to determine the reliability of sex determination from teeth pulp tissue. Patients and methods: This study was carried on 60 maxillary and mandibular premolars and permanent molars (30 male teeth and 30 female teeth) which were indicated for extraction. The teeth were categorized into three groups of 20 each (10 from males and 10 from females). Group 1-pulp tissue from teeth examined immediately after extraction. Group 2- and Group 3-pulp tissue examined from teeth one and five month after extraction, respectively. Teeth was sectioned and pulpal cells were stained with quinacrine dihydrochloride. The cells were observed with fluorescent microscope for fluorescent body. Gender was determined by identification of Y chromosome fluorescence in dental pulp. Results: Freshly extracted teeth and for those examined one month later, sensitivity, specificity, positive predictive value, negative predictive value, and efficiency were all 100%. Conclusion: The fluorescent Y body test is shown to be a reliable, simple, and cost-effective technique for gender identification in the immediate postmortem period up to one month. Keywords: quinacrine dihydrochloride; sex determination; tooth pulp tissue (Published: 1 April 2010) Citation: Libyan J Med 2010, 5: 5084 - DOI: 10.3402/ljm.v5i0.5084
TL;DR: It seems majority of diabetic patients in Libya manage to fast during Ramadan month, and patient education and early planned adjustment of diabetic medication is needed to decrease the frequency of diabetic complication during Ramadan week.
Abstract: Background: The epidemiology of diabetes and Ramadan fasting was reported from many Muslim countries, but not from Libya. Methodology: We interviewed 493 consecutive diabetic patients at Benghazi Diabetes and Endocrine Center for the potential complications of fasting during Ramadan. Results: We found 70% of diabetic patients completed the 30 days of Ramadan fasting. Hypo- and hyperglycemia was the most commonly reported complications especially during the first two weeks of Ramadan month. Conclusion: It seems majority of diabetic patients in Libya manage to fast during Ramadan month. Patient education and early planned adjustment of diabetic medication is needed to decrease the frequency of diabetic complication during Ramadan month. Keywords: diabetes; hypoglycemia; hyperglycemia; fasting; Ramadan (Published: 4 March 2010) Citation: Libyan J Med 2010, 5 : 5036 - DOI: 10.3402/ljm.v5i0.5036
TL;DR: Most of the students are aware that oral health is a component of general health and that it has an impact on an individual's daily life, as evident by the percentage that perceived scaling and polishing as a treatment need.
Abstract: Objective: To determine the perceived oral health status and treatment needs of Nigerian dental therapists in training and dental technology students. Methods: A descriptive cross-sectional study of students from Federal School of Dental Therapy and Technology Enugu, Nigeria was conducted using self-administered questionnaire to obtain information on demography, self-reported oral health status, knowledge of impact of oral health on daily life activity, dental attendance and perceived dental need. Results: The perception of oral health status and treatment need of the two groups of dental auxiliaries was the same. Fewer respondents (27.3%) rated their oral health as excellent, while 50.4% rated their oral health as good. Majority (95.5%) agreed that oral health is a part of general health and 94.6% agreed that oral health has a role in daily life. Out of 81.4% that had previous dental treatment, scaling and polishing accounted for 66.1%. Presently, 48.8% think they need dental treatment ranging from scaling and polishing (33.9%), tooth restoration (10.3%), to extraction (1.2%). Conclusion: This survey revealed that most of the students are aware that oral health is a component of general health and that it has an impact on an individual’s daily life. More than half of the students perceived their oral health as good, but only a few knew that there is a need for a preventive approach to oral health as evident by the percentage that perceived scaling and polishing as a treatment need. Keywords: oral health; status; dental auxiliaries (Published: 15 March 2010) Citation: Libyan J Med 2010, 5: 4859 - DOI: 10.3402/ljm.v5i0.4859
TL;DR: Another technique of dealing with a stuck and encrustated catheter is described, via direct crushing of the encrustations with a rigid cystoscope inserted through a suprapubic cystostomy tract.
Abstract: Urinary bladder catheter encrustations are known complications of long-term urinary catheterisation, which is commonly seen in clinical practice. These encrustations can impede deflation of the balloon and therefore cause problems in the removal of the catheter. The options in managing an encrusted and incarcerated urinary bladder catheter include extracorporeal shock wave lithotripsy and lithoclast. We describe here another technique of dealing with a stuck and encrustated catheter, via direct crushing of the encrustations with a rigid cystoscope inserted through a suprapubic cystostomy tract.
TL;DR: There is a need to address the issue of enhancement of remuneration for ophthalmologists in Nigeria with a focus on job satisfaction and readiness to pursue a career in ophthalmology if they were to make a choice again.
Abstract: Aim: This study aimed to assess job satisfaction amongst Nigerian Ophthalmologists. Methods: The study was conducted during the annual congress of the Ophthalmological Society of Nigeria in September 2008. One hundred and ten ophthalmologists were selected by simple random sampling and asked to complete a structured questionnaire. Results: The response rate was 73%. The resulting sample comprised of 48 consultants (60%), four diplomates (5%), and 28 residents (35%). Most respondents 62 (78.5%) were satisfied with their job as ophthalmologists and 17 (21.5%) were not satisfied. Only 12 (15.4%) were satisfied with their remuneration and 42 (53.2%) were satisfied with their skill. Most respondents (75.6%) expressed readiness to pursue a career in ophthalmology if they were to make a choice again. Conclusion: Most respondents were satisfied with their job but only minorities were satisfied with their remuneration. Therefore, there is a need to address the issue of enhancement of remuneration for ophthalmologists in Nigeria. Key words: Ophthalmologists, Job satisfaction, Nigeria (Published: 8 January 2010) Citation: Libyan J Med 2010, 5: 4629 - DOI: 10.4176/091010
TL;DR: This study investigated MRSA collected isolates for MLSB phenotypes, in particular inducible clindamycin resistance (MLSB i), which is responsible for both hospital and community-acquired infections.
Abstract: Methicillin-resistant Staphylococcus aureus (MRSA) first emerged as nosocomial pathogens in the early 1960s are of great concern to public health and highly reported in human clinical samples. There are major international concerns about rising levels of MRSA and multi-drug resistant S. aureus owing to the difficulties of treating infections and the ease with which MRSA spreads within hospitals. Until recently, most infections of MRSA were acquired primarily in hospital settings, but now MRSA is responsible for both hospital and community-acquired infections. The objective of this study was to investigate MRSA collected isolates for MLSB phenotypes, in particular inducible clindamycin resistance (MLSB i ). (Published: 13 January 2010) Citation: Libyan J Med 2010, 5: 4636 - DOI: 10.3402/ljm.v5i0.4636
TL;DR: The prevalence of somatisation and psychologisation is comparable with other reported studies from the Middle-East and Western countries and dissatisfaction at work and stressful life events were significantly higher among STs than PGs.
Abstract: Background: Medically unexplained somatic complaints are among the most common clinical presentations in primary care in developing countries and they are considerable burden for patients and health care system. Objectives: The aim of this study was to determine the prevalence of somatisation in comparison to psychologisation among a sample of Qatari patients who were visiting primary health care (PHC) centres and to investigate the clinical and socio-demographic characteristics of somatisers (STs) and psychologisers (PGs). Method: The survey was conducted among PHC Qatari patients during the period from January to July 2007. About 2,320 patients were approached, of whom 1,689 agreed to participate and responded to the questionnaire. Among the studied Qatari patients, 404 patients were identified for clinical interview. The first stage of the study was conducted with the help of general practitioners, using the 12-item General Health Questionnaire. The second stage was carried out by a consultant using the Clinical Interview Schedule. A specific operational criterion was used to identify STs and PGs. Results: The prevalence rate of STs among the total studied sample was 12.4%, while the PGs were 11.5%. Among the identified psychiatric cases, the proportion of STs (52%) was higher than PGs (48%). Most of the diagnostic categories were more prevalent among PGs. The dissatisfaction at work and stressful life events within 12 months before the onset of the presenting symptoms were the three postulated determinants which were significantly more among STs than PGs. Conclusion: The prevalence of somatised mental disorder was little higher than the psychologised mental disorder. The prevalence of somatisation and psychologisation is comparable with other reported studies from the Middle-East and Western countries. Dissatisfaction at work and stressful life events were significantly higher among STs than PGs. Keywords: somatisers; psychologisers; primary health care; determinants; Arab culture (Published: 16 June 2010) Citation: Libyan J Med 2010, 5: 5266 - DOI: 10.3402/ljm.v5i0.5266
TL;DR: Hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infections represent a global public health problem and effective vaccine is available only for HBV.
Abstract: Hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infections represent a global public health problem. Transmission of these viruses occurs via blood and blood products transfusion and by sexual contact. The infections caused by the three viruses are not curable even with the latest available treatments. Effective vaccine is available only for HBV. (Published: 14 December 2010) Citation: Libyan J Med 2010, 5 : 5333 - DOI: 10.3402/ljm.v5i0.5333
TL;DR: It is shown that sleepwalking is common in the population in Ile-Ife, in Southwestern Nigeria and adequate efforts should be made for early detection and prompt management of the condition.
Abstract: Background: Sleepwalking consists of a series of behavioral activities that occur during sleep. These activities may be simple, complex or aggressive in nature. They include motor activities, confusion, and amnesia for the events. Sleepwalking is a disorder of arousal from non-rapid eye movement (NREM) sleep. In children, episodes of sleepwalking are rarely violent; in adults, however, sleepwalking might include violence, which could endanger the patient or others and might precipitate legal issues. There is inadequate information on the prevalence and demographic correlates of sleepwalking in Nigeria. Objectives: One objective of this study was to determine the lifetime prevalence rate of sleepwalking in an adult population in Ile-Ife, in Southwestern Nigeria. Another objective was to determine the age and sex distribution of sleepwalking among those who have experienced it at least once in their lifetime. Materials and Methods: A random sample of 228 healthy individuals aged 18-60 years was obtained and the members were asked to fill out a survey form about lifetime prevalence rate of sleepwalking. Results: The overall lifetime prevalence rate of sleepwalking was 7% (16 of 228 participants). It was 10.4% in males and 3.5% in females, but the difference was not statistically significant (p=0.07). Conclusion: This study has shown that sleepwalking is common in the population. In view of the psychological effects of sleepwalking and the potential physical and legal problems associated with it, adequate efforts should be made for early detection and prompt management of the condition. Keywords: sleepwalking; somnambulism; sleep disorder; parasomnia (Published: 7 January 2010) Citation: Libyan J Med 2010, 5: 2143 - DOI: 10.4176/090907
TL;DR: Most of the dental therapy and technology students had satisfactory tooth-brushing behaviour and the zeal to educate others about proper tooth brushing revealed in this study suggests that the students may be helpful in oral health promotion.
Abstract: Objective: To determine the tooth brushing, tongue cleaning and snacking behaviour of dental technology and therapist students. Methods: A descriptive cross-sectional study of students of Federal School of Dental Therapy and Technology Enugu, Nigeria. Self-administered questionnaire was used to obtain information on demography, frequency, duration and technique of tooth brushing and tongue cleaning as well as information on consumption of snacks. Results: A total of 242 students responded. Dental technology students made up 52.5% of the respondents and dental therapist in training made up 47.5%. Majority (63.2%) of the respondents considered the strength of tooth brush when purchasing a tooth brush and 78.9% use tooth brushes with medium strength. Sevententh (71.9%) of the respondents brush their teeth twice daily and 52.1% brush for 3-5 minutes. About onethird (30.2%) brush their teeth in front of a mirror. Chewing stick was used by 51.7% of respondents in addition to the use of tooth brush. Tongue cleaning was done by 94.2% with only 9.5% using a tongue cleaner. Only 20.2% reported regular snacks consumption. Nine-tenth (90.4%) of respondents were previously involved in educating others, apart from their colleagues, on tooth brushing. Conclusion: This survey revealed that most of the dental therapy and technology students had satisfactory tooth-brushing behaviour. The zeal to educate others about proper tooth brushing revealed in this study suggests that the students may be helpful in oral health promotion. Keywords: toothbrushing; tongue cleaning; snacking behaviour; dental auxiliary students; Nigeria (Published: 12 August 2010) Citation: Libyan J Med 2010, 5: 5208 - DOI: 10.3402/ljm.v5i0.5208
TL;DR: Contamination of carpets in mosques of Tripoli with antibiotic-resistant pathogenic and potentially pathogenic bacteria may pose a health risk to worshipers, particularly, the very young, the old and the immunecompromised.
Abstract: Objective: Isolation of potentially pathogenic bacteria from carpets in hospitals has been reported earlier, but not from carpets in mosques. The aim of the present study is to determine the pathogenic and potentially pathogenic bacteria that may exist on the carpets of mosques in Tripoli, Libya. Methods: Dust samples from carpets were collected from 57 mosques in Tripoli. Samples were examined for pathogenic bacteria using standard bacteriological procedures. Susceptibility of isolated bacteria to antimicrobial agents was determined by the disc-diffusion method. Results: Of dust samples examined, Salmonella spp. was detected in two samples (3.5%, 1 in group B and 1 in group C1), Escherichia coli in 16 samples (28.1%), Aeromonas spp. in one sample (1.8%), and Staphylococcus aureus in 12 samples (21.1%). Multiple drug resistance was observed in >16.7% of E. coli and in 25% of S. aureus. Conclusion: Contamination of carpets in mosques of Tripoli with antibiotic-resistant pathogenic and potentially pathogenic bacteria may pose a health risk to worshipers, particularly, the very young, the old and the immunecompromised.Worshipers are encouraged to use personal praying mats when praying in mosques. Keywords: pathogenic bacteria; antibiotic resistance; carpets; mosques; Tripoli; Libya (Published: 13 September 2010) Citation: Libyan J Med 2010, 5: 5536 - DOI: 10.3402/ljm.v5i0.5536