العدد الثاني
تحميل العدد كامل


VITAMIN D ESTIMATION: PROTOCOLS, CHALLENGES AND RECOMMENDATIONS
تاريخ النشر: 2015-06-30
أسماء عباس (Department of Industrial Pharmacy and Medical Microbiology, Faculty of Pharmacy, Misurata University, Libya)
cavity95@yahoo.com

بثينة قريو (Department of Gynecology and Obstetrics, Faculty of Medicine, University of Misurata, Misurata, Libya)
عبدالباسط أبوغرسة (Department of Medicine, Misurata Central Hospital, Misurata, Libya)
محمد خالد شمبش (Family and Community Medicine Department, Medical Faculty, Tripoli University, Libya)
مسعود العزابي (Tripoli Central Hospital)
نجاة بورشان (Family and Community Medicine Department, Medical Faculty, Tripoli University, Libya)
إبراهيم الأرباح (Consultant obstetrics and gynecology, Misurata central hospital )
بشير المدني (Department of obstetrics and gynecology, Misurata central hospital)
محمد اطرينه (Department of Medicine, in Misurata Central Hospital, Libya)
رمضان الأميل (Consultant surgeon, National Cancer Institute - Misurata, LIBYA)
فرج اطرينه ( Anesthesia and Intensive Care Department in Misurata Central Hospital, Libya)
ميلودة الحمادي (Department of Family and Community Medicine, Faculty of Medicine, Tripoli University. Tripoli, Libya)
أنور القصير (Department of Paediatric, Misurata Teaching Hospital. Faculty of Medicine, Misurata University)
عبدالله ارفيده (Clinical biochemistry Assistant lecturer at Misurata University )
حسام الدين بادي (Surgical department, Misurata Central Hospital)

Abstract... Vitamin D, a pro-hormone, is not only important for bone health, but is also involved in other diseases such as multiple sclerosis, irritable bowel syndrome, type I diabetes, cardiovascular disorders and a variety of cancers. These
findings have emphasized the need for determining vitamin D status in a convenient and cost-effective way. Measurement of vitamin D is not an easy task or straightforward procedure. There are many issues/challenges related to
the testing procedure like different sources and metabolites, lack of harmonization between different methods and
structural problems. In this context, present review highlights the importance of vitamin D determination in human
health and diseases related to its deficiency. Problems associated with vitamin D measurements are also being described. Available methods of vitamin D determination were critically compared in order to gather logical suggestions for reliable and accurate determination. According to the reviewed literature in this regard, inexpensive and
high output methods like Diasorin Liaison Total can be employed for routine use, however, low readings need to be
repeated by LCMS, as the performance of Diasorin Liaison Total drops significantly with very low reading. In addition, more work should be done on standardization.


Keywords : Vitamin D, LCMS, Diasorin Liaison Total

ADMISSION PATTERNS AND OUTCOMES OF YOUNG INFANT IN RESOURCE DEFICIENT HOSPITALS
تاريخ النشر: 2015-06-30

Abstract... To calculate incidence of admission and mortality pattern in admitted young infants and to identify measures to assess and evaluate performance to the existing hospital services to improve facilities and inpatient care. This was a
descriptive study (Longitudinal hospital based study) in Paediatric Department, Misurata teaching hospital, from
January 2012-December 2012. All hospital admissions, of young infant who presented to paediatric department with
clinical symptoms justifies admission are included in the study. Sick infants were routinely investigated according to
a standard protocol. The clinical care during admission was supervised by a consultant paediatrician who was also
responsible for assessment and assigning the final diagnosis at the end of the admission after review of the case
notes and the results of all relevant investigations. There were a total of 384 young infant admitted into the paediatric department during the study period. Thirty four infant deaths were recorded (8.9%) from the total young infant
admitted during this study. Presumed serious infections were the commonest cause of admission among infants <2
months of age (41%), followed by Pneumonia (aged 30–59 days) at 30.7% from total admission of young infants.
Mortality in severe infection was 12.6% from total admitted cases of this group but account for 58.8% from total
mortality in young infant. our data suggest that strategies to tackle the problem of infection in young infant by prevent or treat infection may be of great benefit if we consider value of community based diagnosis and care. I believe
that the discussion of mortality cases provides an adequate means of changing practice patterns which needed to
reduce the mortality in young infant.


Keywords : Resource Deficient Hospitals, Mortality, Young infant, Severe infection.

COLD CHAIN STATUS AND VACCINATION ACTIVITIES AT VACCINATION CENTERS IN TRIPOLI, LIBYA (2015)
تاريخ النشر: 2015-06-30

Abstract... Effective immunization program requires a stable cold chain to maintain potency of vaccines from national stores
through to delivery sites. The integrity of the cold chain is depend on not only the equipment used, but also the people involved and the practices they undertake. To assess the condition of cold chain equipment and the practices
adopted for cold chain maintenance by the vaccinators. The study was designed as cross-sectional, conducted at the
vaccination centers in Tripoli. Cold chain equipments were assessed with regards to their condition, along with the
practices of vaccine providers. The study was conducted during the period from December 2014 to February 2015.
The data was analyzed using SPSS program, and results were presented as frequency and percentage. All vaccination centers in Tripoli were assessed, according to World Health Organization recommendations, 95.7% of refrigerators had proper site, appropriate vaccine packing was detected in 55.3% and proper temperature was found in 42.6%
of refrigerators. During vaccination session 66% of nurses used to wash their hands, most of them were handling the
child properly, while all of them checking the type, the dose of vaccine and reconstitute the vaccine as it should be.
Only 10.6% of nurses did not counsel the mothers about the side effects of vaccine and did not remind them about
the time of the next visit, and 95.7% of the nurses handle the needles and syringes safely. Cold chain maintenance
and practice need improvement; regular staff training and supervision.


Keywords : Immunization, Vaccine, Cold chain, Vaccine providers, Assessment

EFFICACY OF LOW DOSE HEAVY BUPIVACAINE WITH FENTANYL IN SPINAL ANESTHESIA FOR CAESAREAN DELIVERY
تاريخ النشر: 2015-06-30

Abstract... Spinal anesthesia is a preferred anesthetic technique for elective caesarean deliveries, for which hypotension remains a significant side effect. We designed the present randomized trial to test the hypothesis that reducing the spinal dose of local anesthetics results in equally effective anesthesia and less maternal hypotension. One hundred patients with American Society of Anesthesiologists physical status (ASA) I–II, age 19 to 38 years, were randomized
into two groups. The studied cases were admitted in Al-salam hospital, Misurata and Misurata central hospital.
Patients in group A (n=50) were given spinal anesthesia using 10 mg heavy Bupivacaine with 25 µg fentanyl. Patients in group B (n=50) were given spinal anesthesia using 7.5 mg heavy Bupivacaine with 25 µg fentanyl. Vital
signs were monitored, the time it took to reach the T3 dermatomal level, duration of cesarean delivery, duration of
adequate anesthesia. The Apgar score of the newborn were compared between the two groups. Duration of adequate
anesthesia was longer in A group, more patients in the group experienced hypotension. However, Neonatal outcomes were similar in both groups. We conclude that small-dose spinal anesthesia (group B) better in preserving
maternal hemodynamic stability with equally effective anesthesia that for shorter duration, it may be feasible only
when the block can be reinforced using a functional epidural catheter.


Keywords : Bupivacaine, Caesarean delivery, Fentanyl, Spinal Anesthesia, Hypotension

EFFICIENCY OF LATERAL INTERNAL ANAL SPHINCTEROTOMY BY CLOSED METHOD UNDER LOCAL ANAESTHESIA AS AN OUT PATIENT PROCEDURE
تاريخ النشر: 2015-06-30

Abstract... Chronic anal fissure is one of the main proctological disorders encountered in surgical outpatient departments, due
to its high prevalence and the great discomfort involved.Though, the exact aetiology of primary anal fissure is still
unknown, high resting anal pressure caused by increased internal sphincter tone appears to be the underlying pathological factor. So, the aim of this study is to determine the efficiency of the procedure of lateral internal sphincterotomy by closed method under local anaesthesia as an outpatient procedure. The clinical study was undertaken in all
patients (70 patients, mean age 35 years) undergoing lateral closed sphincterotomy for chronic anal fissure (defined
as anal fissure with > 6 weeks symptoms duration) from June 2005 to May 2006 who presented to Surgical OPD,
in our hospital. Among 70 studied patients, 41 (58.5%) were females and 29 (41.4%) males. Age ranged from 16-63
years with the mean age of 35 years. Post-operatively, early complications included minor bleeding in two patients
(3.4%) and incontinence of flatus in five patients (8.6%). In all the patients in our study lateral internal sphincterotomy was performed under local anesthesia and they were followed up for 4 months. 88% of patients were cured of
their symptoms while only in 12% the fissure failed to heal. Lateral internal anal sphincterotomy by closed method
under local anesthesia as an outpatient procedure has very good results in patients with chronic anal fissure who do
not respond to conservative treatment.


Keywords : : Lateral internal anal sphincterotomy, Chronic anal fissure.

END-STAGE RENAL DISEASE IN MISURATA
تاريخ النشر: 2015-06-30

Abstract... The prevalence of End-stage renal disease (ESRD) has been continuously increasing in most of countries. ESRD
requiring renal replacement therapy poses a tremendous burden on health care budgets. Unfortunately, there are
no studies on the epidemiology and prevalence of ESRD in Misurata city, hence, our study was conducted to
assess the prevalence, etiology and risk factors for ESRD patients on haemodialysis (HD) at Misurata city during
the year 2005. This is a descriptive study conducted retrospectively by reviewing files of all patients attending
haemodialysis unit at Misurata Central Hospital during 2005. The total number of ESRD patients undergoing
haemodialysis from January 2005 to December of the same year was 70 patients. Their mean age was 36.4±17.7
years, and of median 37.7 (range 3-69). The male constituted 55.7% while female patients were 44.3% with male
to female ratio of 1.25:1. The estimated prevalence of ESRD was 34.71% patients per 100.000 populations. The
most common causes of ESRD were diabetes mellitus in 28.5% and hypertension in 17.1% followed in order by
undetermined causes in 15.7%, glomerulonephritis in 14.3%, chronic pyelonephritis in 8.6%, drug nephrotoxicity in 5.7%, other less common causes like obstructive uropathy, polycystic kidney disease, gout and IgA
nephropathy also was reported in our study. The most common causes of ESRD were found to be DM and HTN,
affecting young- age population. This suggests that we need to improve our health care system and implementation of effective reno-protective strategies


Keywords : ESRD, prevalence of dialysis, renal replacement therapy, ESRD risk factor, Misurata

LAPAROSCOPIC OVARIAN DRILLING TREATMENT OPTION FOR POLYCYSTIC OVARY AND INFERTILITY
تاريخ النشر: 2015-06-30

Abstract... To find out the effectiveness of laparoscopic ovarian drilling (LOD) in patients clinically and radiologically diagnosed as Polycystic Ovarian Syndrome (PCOS) suffering from infertility and to find out factors that may predict the
outcome of LOD. This prospective study included 186 patients with anovulatory infertility due to PCOS who underwent LOD during the period from January 1st 2007 to December 31st 2008. Diagnosis was made according to the
European Society of Human Reproduction and Embryology (ESHRE) criteria for PCOS. Body Mass Index (BMI),
serum Testosterone level and serum LH was taken from the patients. All patients were followed up till they got
pregnant or for a period of 12 months after the procedure. Out of 186 patients, 102 (55%) conceived after long term
infertility ranged from 3-15 years, Antenatal complications were not significant as there was 1 twins pregnancy, 3
miscarriages and 1 ectopic pregnancy, Patients with Body Mass Index ≥ 35 kg/m2
and serum testosterone level ≥ 4.5
nmol/l seems to be poor responders for LOD, meanwhile those with Serum LH level > 10 IU/L appears to be associated with higher pregnancy rate after LOD. LOD gave good fertility rates in patients with PCOS in which medical
ovulation induction failed, marked obesity and hyperandrogenism are a marked predictor for resistance to LOD,
while high level of LH predicts to a higher probability of pregnancy


Keywords : Laparoscopic Ovarian Drilling, Polycystic Ovarian Syndrome, anovulation, infertility

LATENT HSV-1 INFECTION CAN BE ESTABLISHED IN KERATINOCYTE CELLS FOLLOWING TREATMENT WITH MITOTIC INHIBITORS
تاريخ النشر: 2015-06-30

Abstract... Herpes simplex virus type 1 (HSV-1) infection of murine keratinocyte cell lines (HEL-30 and PAM-212) treated
with mitotic inhibitors leads to silencing of virus replication. At 0.1 (Multiplicity of infection) MOI, PAM-212
keratinocytes showed some cell lysis; and viral plaques were seen in HEL-30 keratinocyte cultures. PAM-212
keratinocytes, infected at 0.01 MOI, were more susceptible to the lytic effect of HSV-1 than were HEL-30 cells. In
this study, 5-fluoro-2`-deoxyuridine (FUDR) treatment of both keratinocyte cell lines permitted an increase survival
of HSV-1- infected keratinocytes especially for PAM-212 cell line which was further examined for the presence of
sequestered virus after treatment with FUDR and infection with HSV-1. In this post-mitotic state, HSV-1-infected
keratinocytes appeared to contain latent virus as suggested by the lack of virus plaques or cytopathic effect (CPE).
After infection, these cells were examined for the presence of replicating HSV-1 in Vero cell overlays. Virus
plaques were found suggesting that latency may have been established


Keywords : HSV-1, Mitotic inhibitors, FUDR, Taxol

MACROSOMIA , PREDICTION AND MODE OF DELIVERY
تاريخ النشر: 2015-06-30

Abstract... The concept of fetal macrosomia and its adverse outcomes has been recognized in medicine and literary reports
throughout the ages , Attempts at perinatal diagnosis of macrosomia have been useful in some cases. The mode of
delivering a borderline macrosomia is a matter of discrepancy. Fetal macrosomia has been defined in several different ways including birth weight of [4000-4500 gm] or birth weight greater than 90% for gestational age after correcting for sex and ethnicity. Based on these definitions macrosomia affect 1- 10 % of pregnancies. It`s an analytic
study aims to detect the possibility of antenatal prediction of fetal macrosomia and the decision for the safe mode of
delivery . The study was done at the obstetric unit of Misurata Teaching Hospital–Libya, over a period of two years
from the first of January 2010 till December 2011. During this period, a total of 17234 deliveries occurred. 100 patients whom delivered babies weighing >4, 500 kg were included in this study. They were randomly selected. maternal complications were observed. The 100 macrosomic infants delivered in the study period were their birth
weight >4500 gm constituted 0,7% of all deliveries; There was a statistically significant increased incidence of macrosomia in the age group 30–40 years which is 50%. The highest incidence of macrosomic pregnancy in women P1
to P3 41% and then P4 to P6 which is 32% and the incidence decreases. In grand multiparous women and also in
primigravida were it 13% in both, The complications were recorded in 20% of all deliveries ,in particular shoulder
dystocia 4% of all macrosomic births, various bone fracture is 3%of all deliveries which occurred more frequently
with operative vaginal deliveries. The ability to estimate the fetal weight appears to be of great importance in identification of macrosomic fetus Clinical estimation along with ultrasound estimation can serve a useful guide to prevent maternal and fetal complications. Most of complicated cases of macrosomic deliveries are from the unpredicted
group


Keywords : fetal macrosomia, maternal and fetal complications, multiparity, diabetes mellitus

PERIOD PREVALENCE OF CRYPTORCHIDISM IN LIBYA
تاريخ النشر: 2015-06-30

Abstract... Cryptorchidism is a congenital condition characterized by testicles do not descend to the scrotum .This is a prospective study aimed to predict undiagnosed cases of undescended testicles, its prevalence in the community and to find
out the risk factors leading to it; as well as the management of this condition. This comprehensive study is carried
out in Alkhadra Hospital, Aljalla Hospital and Zliten Central Hospital over a period from Jan 1 to Dec 31 2013.
Included (342) examined cases. Their age ranged between one week to 5 years old; of which 19 cases (5.6%) were
found to have cryptorchidism. The poor mothers` knowledge about this condition was another finding. Every male
infant should be examined to detect undescended testecls


Keywords : cryptorchidism, prevalence, diagnosis, risk factors and management

PREVALENCE AND CAUSES OF CHRONIC DRY COUGH AT A RESPIRATORY CLINIC IN TRIPOL
تاريخ النشر: 2015-06-30

Abstract... Prolonged dry cough, in the absence of other features that suggest common etiologies, can be a diagnostic challenge.
The aim of this study was to examine the prevalence and causes of isolated chronic dry cough among the patients
who presented to the respiratory clinic in Tripoli Central Hospital during the period from 1st Jan 2005 to 31st Dec
2009. In this prospective study, data from the patients who met the following inclusion criteria was collected; complaint of isolated dry cough for more than 8 weeks, normal chest radiograph, chest physical examination and basal
spirometric values. The post-bronchodilator improvement in the FEV1 was considered significant and suggestive of
cough variant asthma if it exceeded 15% of the baseline value. The diagnosis was confirmed if the cough improved
or disappeared after a short course of steroid therapy. The diagnosis of reflux associated cough was confirmed if it
improved with anti-reflux therapy. The total number of registered patients was 800; 69 consecutive patients (8.6%)
met the selection criteria. The mean duration of cough was (± SD) 113 ± 141 weeks (range; 8-720 weeks). Their
mean age (± SD) was 32 ± 13.2 years (range; 15-75 yrs). Thirty- nine were females (56.5%), and 8 were current or
ex-smokers (11.5%). In 56 patients (81.15%) the likely diagnosis was cough variant asthma (CVA). Out of them;
45 (80%) had associated allergic rhinitis too. All of the CVA patients received a short course of oral steroids in addition to bronchodilator inhalers. In another 7 patients (10.1% of total and mostly males (71.4%)); the likely diagnosis
was gastro-esophageal reflux disease (GERD) related cough and they responded to anti-reflux therapy. In the last 6
patients (8.7%) who were male smokers; no clear diagnosis was established. They received bronchodilator therapy
and were advised to stop smoking. CVA was highly prevalent cause of chronic cough (81.15%) in the study group.
Most of the CVA patients had rhinitis too (80%) and the contribution of post nasal drip to the etiology of cough is
difficult to establish. 56.5% of the CVA patients were females and of younger age. GERD related cough was less
prevalent (10.1%) and was mostly in males.


Keywords : Chronic dry cough, Cough variant asthma

STROKE RISK CLASSIFICATION BY CHADS2 SCORE IN COMMUNITY POPULATION IN ABSENCE OF ATRIAL FIBRILLATION
تاريخ النشر: 2015-06-30

Abstract... CHADS2 score is a proven, simply calculated, essential tool for estimating cardioembolic risk (mainly stroke) in
patients with nonvalvular atrial fibrillation (AF). The CHADS2 score is used in clinical practice to guide decisions
regarding antiplatelet and anticoagulation therapy. The study aimed to evaluat the performance of the CHADS2
score & Community Stroke Risk Classification (CSRC) to classify stroke risk factors in population without AF. This
study was conducted as a community based descriptive cross-sectional study in North Africa (North West of Libya),
among individuals living in Tripoli area "the capital". It was done by Department of Community & Family Medicine, Faculty of Medicine, University of Tripoli. Duration of the study was five years from 1/1/2010 to 31/12/2014.
Data was collected using CHADS2 and CSRC scores; Total of 7497 individuals (52.8% males & 48.2% females)
were interviewed by taking detailed histories (present, past, medical, hospital admission), checking of any available
investigations, discharge letters and medical reports and perform medical examinations. Among 7497 screened,
64.2 % (4814) had risk factors (RF) of stroke and 35.8% (2682) have no risk on CHADS2 score corresponds to low
stroke risk. Among population having CHADS2 risk score, 64.3% (3096) have intermediate risk score, corresponds
to intermediate or moderate stroke risk. 1719 (35.7%) had high risk score corresponds to a greater high stroke risk.
On Community Stroke Risk Classification (CSRC), majority of the population having stroke risk score grades with
one or more risk factors (64.2%). Among 4814 had risk factors of stroke, The analysis showed significant difference
in CSRC score grades (P<0.01), the majority of the population having intermediate score grades (1-2
RF)(69.4%)(P<0.001), IRS1 (41.4%) and IRS2 (27.9%). High score prevalence (≥3 RF) was 30.6%, with decrease
in percentages with HRS3 (16.5%), HRS4 (9.5%), HRS5 (3.7%) and the lowest is HRS6 (0.9%). Males showed
significant raise compared with females in all score grades especially in intermediate score risk (1-2 RF) (P<0.004).
Intermediate score (1-2 RF) is dominated in all study age groups compared with high scores (3-6 RF)(P<0.001);
16-49 years (67% for 1-2 RF, 33% for 3-6 RF) and 50-80 years (51.1% for 1-2RF, 48.5% for 3-6RF). Hypertension
and Diabetes were the major risk factors of stroke on all scores and highest among intermediate score (1-2 RF)
(P<0.001). This study confirmed that stroke is a major public health problem in North Africa. CHADS2 & CSRC
scores are very useful and simple method to classify stroke among population without AF.


Keywords : Stroke, CHADS2 score, Prevalence, Risk factors, Classification, Community, Atrial Fibrillation, Africa.

THE SCOPE OF THROMBOLYTIC THERAPY AMONG ST SEGMENT ELEVATION MYOCARDIAL INFARCTION IN MISURATA CENTRAL HOSPITAL
تاريخ النشر: 2015-06-30

Abstract... Little is known about thrombolytic therapy patterns in patients with ST-elevation myocardial infarction (STEMI) in
Libya. The objective of this study is to analyze the use of thrombolytic therapy in patients with ST-Elevation Myocardial Infarction (STEMI) in Misurata Central Hospital. The study includes 73 patients diagnosed with STEMI,
from hospital admission to discharge, from a total of 125 patients with acute myocardial infraction admitted to
Misurata Central Hospital cardiology care unit between January and December of 2009. RESULTS of the 73 patients
with STEMI, 52% (n=38) were thrombolysed with Streptokinase, Alteplase, and Tenecteplase. 14% of eligible
STEMI patients did not receive reperfusion therapy. The age of patients varied from 31 to 80 years of age, with a
median age of 55.9 years, a majority of 84% being male. The overall median symptom onset- to hospital presentation was 4 hours in thrombolytic recipient patients and 20 hours in non recipient patients. The median door to needle
time was 34 minutes. Poor left ventricular ejection fraction was less than 30% and reported more in nonthrombolytic recipient patients. Thrombolytic recipient patients were less likely to develop left ventricular failure.
The global in-hospital mortality rate for STEMI patients in 2009 was 8%. Thrombolytic therapy is the only form of
reperfusion strategy in Misurata. There was inappropriately long symptom-onset to hospital presentation as well as
door- to needle times. Thrombolytic agents improve morbidity but early mortality was relatively high, which needs
further exploration.


Keywords : Acute coronary syndrome, STEMI, thrombolytic agents, efficacy, mortality, Misurata

DECISION-MAKING FOR USE OF INJECTABLE CONTRACEPTIVES IN ALEXANDRIA, EGYPT: A COMPARATIVE STUDY
تاريخ النشر: 2015-06-30

Abstract... Injectable contraceptives are considered one of the modern methods that help in the rapid increase of the prevalence
of family planning methods all over the world. In the past few years their use has increased considerably. To identify the potential factors affecting the decision to use injectable contraceptives in Alexandria, Egypt. A cross-sectional
study was carried out in 26 family planning clinics affiliated to the Ministry of Health (MOH), Alexandria, Egypt.
The study was conducted for seven months during October 2006 - April 2007. Alexandria has seven health districts;
each district was represented by one clinic selected randomly from each type of the following 4 types of facilities:
rural units, urban maternal and child health centers, hospitals, and health offices. They were selected by using the
multistage stratified random sample technique. Totally 26 clinics were selected as two districts had no rural units.
The sample size was 790 clients. All clients (new acceptors, current users, continuers and discontinuers of all methods) were interviewed using two predesigned questionnaire. The use of all methods was affected by the positive
attitude of the husband towards the use of contraceptive methods. Refusal of husbands to use methods led to the
covert use of injectable contraceptives in only 2.3% of clients. Nearly all current users discussed family planning
with their husbands and, nearly 75% of wives expected that their husbands would discuss use freely. A higher proportion of new users expected refusal of use of family planning methods by their husbands than current users (25%
versus 5.4%). None of new users expected their husbands would be aggressive during the discussion or to refuse
discussion from the start. A considerable proportion of new users of injectable contraceptives changed to other
methods after being counseled by health providers. Service providers (physicians and leaflets) were not the main
source of information; they represented only 6% of information sources. The main sources of knowledge about the
injectables were friends and peers (65%) and television (29%). The main rumor heard about injectables was that
they cause infertility (56.9%) followed by causing breast tumors (10.8 %). Decision to use injectable contraceptives
depends not only on women acceptability of the method but also on husbands’ and health providers’ attitudes and
beliefs, as well as friends’ opinion about injectables and also on rumors.


Keywords : injectable contraceptives; decision-making; use; Alexandria

ASTHMA MIMICS (ACUTE RESPIRATORY FAILURE CAUSED BY GIANT RETROSTERNAL NONTOXIC GOITER)
تاريخ النشر: 2015-06-30

Abstract... A 70 years old Libyan lady complaining of dyspnea and was treated as bronchial asthma for 3 years. She was admitted to the medical ward; as her condition worsened recently; where she re-evaluated and diagnosed as acute respiratory failure caused by giant retrosternal nontoxic goiter