Abstract... Acute coronary syndrome (ACS) is the leading cause for coronary care unit admissions. It ranges from non-STelevation acute coronary syndrome (NSTEACS) including non-ST-elevation myocardial infarction and unstable
angina to acute ST-segment elevation myocardial infarction (STEMI) . Our aim was to study the clinical picture,
management and outcome of ACS patients admitted to the coronary care unit (CCU) at a tertiary heart centre in
Tripoli-Libya. A retrospective study was performed on the spectrum of ACS in subjects admitted to the CCU in
Tajoura National Heart Center from January 2014 to December 2014. Details including coronary risk factors, categories and outcomes were analyzed. A total of 84 patients were included in the study, the majority 64 (76.2%) were
males. their mean age was 58± 14 years, 22(26.1%) were < 50 years, and the most common age group was from 50
to 59 years. The majority 60 (71.4%) had STEMI and 24 (28.6%) had NSTEACS. The major coronary disease risk
factors were; diabetes 38 (45.2%), hypertension 38 (33.3%), history of ischemic heart disease 18 (21.4%), chronic
kidney disease (CKD) 15 (17.9%) and smoking 41 (48.8%). According to GRACE score, 13 (15.5%) were categorized as high risk, 13 (15.5%) intermediate risk and 56 (66.7%) low risk. 30 patients (35.7%) received thrombolytic
therapy, 33 (39.3%)underwent percutaneous Coronary intervention (PCI), 6 patients (7.1%) received both forms of
therapy. The mean duration of CCU stay was 4.26 ± 5 days. 11 (13.1%) patients died in the CCU including 6 (10%)
with STEMI and 5 (20.8%) with NSTEACS, their. The mortality was more among the older patients (mean age was
68.45 years ± 14.6) (P.008) and the likelihood ratio of death was more in; females (2.9), CKD patients (2.5), high
grace score (10.45) (P .008) and in patients who did not undergo PCI (12) (P.004). In this study, the ACS patients
were of relatively younger age, higher prevalence of diabetes and higher GRACE risk score. Compared with the
European centers; PCI was less (almost half) performed and fibrinolytic therapy was more used in STEMI, and PCI
was less performed in NSTEACS. The CCU mortality was high and further studies are needed to evaluate it’s the
underlying reasons.
Abstract... Idiopathic, non-congenital Nephrotic syndrome (NS) of childhood is characterized by massive proteinuria and hypoalbuminemia, leading to oedema and hypercholesterolemia. Other clinical findings, such as haematuria and hypertension, are observed in a small fraction of patients. To identify the exact pattern of NS in Libyan children, incidence of disease, and out-comes of NS. This study was retrospectively carried out on 329 children (227 male
and102 female), male: female was 2.2:1, aged (mean=4.9 ±3.2 year) at the onset of the disease. All patients with
Idiopathic Nephrotic Syndrome. This diagnosis was made according to the criteria of the international study of kidney disease in children (ISKD). An average admission at Nephrology ward was 214 cases/ year; correspond to 5%
of total hospital admission. 30.3 % were newly diagnosed Nephrotic Syndrome (65 newly diagnosed nephrotic patients ∕ year). Sixty nine % of children were with good sensitivity to steroid, 24.3% with steroid dependent and 6.7%
were steroid resistant. Viral screen was done in 226 patients 68% ,28 children were positive for HCVAb by ELISA
8.5% of total cases,HBSAg was positive in one female ,no one with HIV. HCVAb positive cases 78.57% of them
were steroid dependent & steroid resistant with frequent admission. The out-comes were as follow; 18 patients got
hypertension, one patient with DM, two patients with hypothyroidism, one patient with cataract and glaucoma , 8
patients were died and 135( 41.3%) got complete remission. with regular treatment and follow up, the prognosis of
idiopathic Nephrotic syndrome is good,with better organized schedules of management, has substantially reduced
the Mortality of SRNS (steroid responder Nephrotic syndrome), but death still occurs, primarily from hypovolemia,
Thrombosis and sepsis. Relapses eventually cease. Blood pressure and renal function remain Normal.
Abstract... To determine the safety and effect on quality of life of Laparoscopic assisted vaginal hysterectomy (LAVH) compared with total abdominal hysterectomy (TAH) in the management of benign gynecological diseases. Randomized
controlled trial in Misurata Cancer Institute. Ninety women scheduled for an abdominal hysterectomy for benign
gynecological diseases. The overall incidence of operative complications was 13% in LAVH group and 22% in
TAH group, with an 4.4% conversion rate . The mean length of the procedure was greater in women having LAVH
(85 minutes) compared to TAH (35 minutes), there was a difference in post-operative analgesia requirements between the two groups; TAH needed more analgesics and needed more hospital stay than LAVH group .The rate of
postoperative recovery, satisfaction with the operation, and quality of life at four weeks post-operative were more
with LAVH GROUP than TAH group. LAVH compared to TAH has the advantages of faster return to normal activity, shorter duration of hospital stay, lower intra-operative blood loss and fewer wound or abdominal wall infections
but it has longer operation time, higher rate of lower urinary tract (bladder and ureter) injures and needs more experience.
Abstract... Pathology education includes an important visual part supporting a wide range of theoretical knowledge. However,
the use of traditional microscopes in pathology education has declined over the last decade and there is a lack of
interest for microscopy. Virtual microscopy, which was first described in 1985 and has experienced a revolution
since 2000, is an alternative technique to conventional microscopy, in which microscopic slides are scanned to form
digital images and stored in the web. The aim of this study was to evaluate the use of virtual microscopy in practical
pathology sessions and its effects on our students and undergraduate education at our faculty. Forty third year
medical students who were used to conventional microscopes were included in the study. The practical sessions
were carried out via virtual slides and the effect of the new technique was investigated by a scale at the end of the
general pathology module. Academic staff from the pathology department joined sessions to promote discussion and
respond to questions. Student ratings were analysed statistically. The evaluation of the ratings showed that the
students were easily adapted to the use of virtual microscopy. They found it user-friendly and thought that the
opportunity of viewing slides at home was advantageous. Collaboration between students and interactive discussions
was also improved with this technique. It was concluded that the use of virtual microscopy could contribute to the
pathology education of our students.
Abstract... Mid-upper arm circumference (MUAC) has been used as alternative indicator of nutritional status, if the collection
of weight and height was difficult, such as during emergency, famine, or refuge crises. The aim of this study is to
construction new arm circumferences charts for Libyan Preschool Children to use as screening tool in nutritional
assessment. Data were taken from two cross-sectional studies carried out in 3 regions of western part of Libya
(Tripoli, Al jafarh and Al-Jabel Al-Gharbi) between the years 2000 and 2010 by the principle author and his team
following World Health Organization (WHO) methodology. A simple random sampling technique was used to obtain participants from MCH centers, kindergartens and the delivery section of obstetric hospitals. A sample of 2014
Libyan preschool children from both sexes were recruited from different places in Libya. Selected percentiles (P3,
P10, P25, P50, P75, P90, and P97) are presented for boys and girls of under five years according to age. New
MUAC charts were made for Libyan preschool children, to provide health workers in Libya with tool that should be
useful in screening or as a clinical and research tool for adequacy of growth during the first five years of life in
Libya.
Abstract... Plague is not ended even in developed countries. There have been many out- breaks around the world right up to the
present time. The disease is introduced by infected rats, transported to humans by rat fleas. Tobruk is semiarid area,
usually rainfall in winter is from 65 to 120 mm. In 2009, increased winter precipitation to 220 mm, enhanced small
mammal food resource productivity ( plants and herbs ), leading to an increase in the abundance of plague hosts.
Moisture may act to promote fleas survival and reproduction, also enhancing plague transmission. The study included 16 villages and 5 districts Tobruk city. Suspected cases were admitted to Tobruk Medical Centre, clinically and
laboratory diagnosed, and treated with antibiotics. The outbreak of plague started from March to July, 138 persons
were struck down by the infection with Yersinia pestis, of whom 6 cases (4.35% ) died.
Abstract... RCC is the most lethal of common urologic cancers; it is the most frequently occurring solid lesion within the kidney and comprises different types with specific histopathological characteristics for each. By using different diagnostic tools and advancement of imaging techniques there is an increase in the number of incidentally discovered
renal tumors, these tumors are smaller and of lower stage. However, Current radiologic techniques of CT, US, or
MRI do not distinguish histologic subtype of small renal cortical neoplasms. Despite the increased incidental detection rate, the mortality from RCC has remained unaffected and parallel to the incidence. The aim of this study is to
evaluate the cases of renal cell carcinoma regarding the age and sex of patients presented with renal tumor, symptoms at the time of presentation, physical findings, results of laboratory investigations, imaging study results and
complications of surgery as well as histopathological results. The study was performed by reviewing 23 patient`s
files of renal mass who admitted to urology center in the period from Aug 2009 to Aug 2014. Out of 23 cases of
RCC, approximate 61% were males and 39% were females of different age groups with the mean age 59 years and
the ratio of male to female is 1.6:1. However, the peak incidence of occurring RCC between 50-70 years of age and
represents approximately 52% of all cases. The most common presenting symptoms were flank pain with or without
other urological symptoms and accounts about 48% of all cases and hematuria with or without other urological
symptoms recorded in about 39% of cases, however, about 30% of cases were discovered incidentally and considered as the third most common presenting figure of disease. On physical examination there were no obvious abnormal physical findings in about 52% cases, while in about 39% cases the tumor was palpable. Laboratory results
was normal in about 43% of patients. However, about 35% of patients were anemic, while ESR was high in about
30% of patients. The imaging studies disclosed right side renal tumor in 43% patients and left side renal tumor in
48% of patients while bilateral renal tumors detected in about 9 % of cases. The size of the tumor was less than 7 cm
in average diameter in 60% of patients while in 40% of patients the tumors size was more than 7 cm in average diameter. The sites of renal tumor were at upper in 56% of cases, at mid portion in 4% of cases, at lower pole in 28%
of cases while the tumor was diffuse in 12% of cases. The histopathological results of resected renal masses as follow conventional (clear-cell) cell carcinoma in 50% of cases, papillary-cell carcinoma in 15% of cases Chromophobe-cell carcinoma 5% of cases. However, Unclassified-cell carcinoma found in 30% of cases. The widespread
use of abdominal computed tomography and ultrasonography during the diagnostic imaging of nonspecific abdominal complaints has led to the increased detection of incidental small renal masses causing no obvious symptoms. Surgical resection still remains the only effective treatment, however, local recurrence without evidence of
metastatic disease is a distinctly rare event. Finally there are no uniform guidelines that have been established for the
follow-up of patients who have undergone surgical treatment of RCC.
Abstract... Vancomycin resistant enterococci have become a major concern worldwide. The aim of this study is to isolate and
identify enterococcal species from different clinical specimens as well as to determine the susceptibility pattern of
these isolates to vancomycin. The present study was carried out in two hundred (72 males and 128 females) patients
who attended different clinical wards at Al-Khums teaching Hospital, Al-Khums, Libya, during May 2011 to November 2012. All isolated enterococcal species were identified using gram staining and biochemical tests using API20E system. Antimicrobial susceptibility testing was also performed. The overall enterococcal infection rate was
31.5% of the total specimen examined. It was found that out of 37 wound specimens only 5 (13.5%) showed enterococcal infection. The results indicate that the isolation rates of enterococcal isolates are usually more or less equally
distributed among both male and female patients concerning throat swabs, sputum and wound specimens. However,
the isolation rates of enterococcal isolates from urine specimens were higher in case of female patients (20.5 %)
compared with that (6.5%) of male patients. Three different enterococcal species(Enterococcus faecalis, Enterococcus faecium and Enterococcus avium) were identified. Antibiotic susceptibility results indicated that 6 isolates of E.
faecalis, one isolate of E. ovium were resistant to vancomycin and no isolates with vancomycin resistant in E. faecium.
Abstract... Retinopathy of prematurity (ROP) is a proliferative retinopathy affecting premature infants of very low birth weight,
who have been exposed to high ambient oxygen concentrations. With improvement in neonatal care and advancement of oxygen therapy control, more preterm infants are surviving with a resultant increase in the number of ROP
cases. The aim of the study is to determine the incidence and risk factors associated with ROP in low birth weight
infants. This prospective study conducted in Albasar Ophthalmology Clinic from May 2015 to September 2016 and
includes the result of fundus examination of 52 premature infants referred from Asalam Hospital (neonatology department) Misurata - Libya. All preterm infants received oxygen therapy by nasal tube or ventilator. 5 (9.6%)
premature infants found to have ROP, all preterm infants were advised for a regular follow up. The age at first
presentation varies from 3 to 13 weeks. Gestational age ranges between 27 to 31weeks. Birth weight ranges between
1000 to 1500 grams. Incubation period ranges from 2 to 45 days. Six babies were lost before completing the fundus
examination. All the infants with the disease were more than 9 weeks old on first presentation and only one infant
had birth weight more than 1250 grams. Two (3.8%) infants had severe ROP at least in one eye. It seems that this
disease is a common problem in this city. Community education, government supply of diagnostic and therapeutic
equipment will help early detection, proper management and reduce the incidence of the disease.
Abstract... The LigaSure Vessel Sealing System (Valley Lab, CO,USA) is abipolar diathermy system that seals vessels with
reduced thermal spread and has been introduced as a new method for hemostasis during thyroidectomy. This report
review our experience with use of ligaSure in thyroid surgery in one hundred twenty patients. This study was conducted in 7th October, Jala hospital and Benghazi Medical Centre, University Hospitals, Benghazi-Libya, On one
hundred twenty patients who underwent thyroid surgery from June 2007 to December 2010. The medical records of
the patients were collected and reviewed retrospectively regarding age, sex, histopathological diagnosis, type of operation performed (hemithyroidectomy vs. subtotal thyroidectomy vs. total thyroidectomy), operating time, postoperative complications and hospital stay. There were 17 males and 103 females (3 children), with a mean age of 42
years, mean operative time was 57 minutes, one patient died (mortality 0.8%) due to pulmonary embolism and postoperative morbidity rate was (6.6%) 8 patients. Use of the LigaSure in thyroid surgery is a safe method with minimal complications, good haemostasis and significantly reduce operating time.
Abstract... Cyclophosphamide (CP) is an antineoplastic agent used for the treatment of many neoplastic and inflammatory diseases. Hemorrhagic cystitis is a frequent side effect of CP. Several studies show’s that atorvastatin has important
pleiotropic (anti-inflammatory and immunomodulatory) effects. The purpose of the study was to investigate the effect of atorvastatin in prevention from HC induced by CP. Thirty rats were divided into 5 main groups: Control, CP,
CP and MESNA, CP and Atorvastatin, CP- MESNA and Atorvastatin. The bladder was collected and histopathological evaluated. Atorvastatin Show’s significant reduction in HC scoring, MESNA still superior than Atorvastatin in
prevention of HC, combination both Ator And MESNA show’s no additive effect.
Abstract... Our objective is to determine the complication rate in children from a Alexandria University Hospital Cochlear Implant program and to discuss their causes and treatments. The methods include a retrospective study of 175 consecutive patients in otorhinolayrngology department of the Alexandria University Hospital. All patients receiving cochlear implants, from 1 January 2003 to 31 July 2014, have been included. All complications and treatments including
that which related to plastic surgery were systematically reviewed with an average duration of follow-up to 6
months . The results reveal that the overall rate of complications in our group was 15.4% (27 of 175). Wound infections represent the most common complication occurred. There were no cases of postsurgical meningitis. Two patients (1.1%) underwent exploration followed by reimplantation. In conclusion, we find that Cochlear Implantation
is a safe low-morbidity technique with a relatively low complication rate in the presented population.
Abstract... Obstructive sleep apnea (OSA) syndrome is a major health problem affecting 2 to 4% of the middle-aged population, so screening tests had to be established for the diagnosis of sleep-related breathing disorders. However, there is
a great demand for polysomnography (PSGs), performing PSGs is a costly, labor-intensive uncomfortable technique
and also not available in all areas. As oxygen saturation is often used as a main diagnostic criterion of these screening tests, so it is important to study the correlation between overnight oximetry and degree of obstructive sleep apnea. To investigate the relative usefulness of pulse oximetry in the diagnosis of OSA, and to determine sensitivity
and specificity of average O2 saturation and minimum O2 saturation in predicting the degree of obstructive sleep
apnea. This study was conducted during the period from December 2014 to November 2015 in Misurata, Libya. It
included 120 patients (52 women, 68 men) suspected to suffer from sleep apnea-syndrome. Participants underwent
pulse oximetry recordings which was performed simultaneously during polysomnography for suspicion of OSA.
Then oxygen saturation (pulse oximetry) was compared with respiratory disturbance index (RDI, polysomnography). An RDI ≥ 5/h and a minimal oxygen saturation < 90% and/or more than 5 oxygen desaturations/h ≥ 4% were
regarded as pathological. We found high statistically significant positive correlation between the severity of RDI
with average O2 saturation and O2 Saturation Minimum. Minimum O2 Saturation is better than average O2 Saturation in predicting the severity of RDI and better in predicting severe cases than mild cases (Sensitivity = 70.6 % ,
Specificity = 80.8 % and Accuracy = 75.9 % at cutoff "Minimum O2 Saturation ≤ 79.5 %").We concluded that
pulse oximetry in combination with a positive case history is a sensitive method to recognize sleep apnea-patients.
Abstract... Chlamydia pneumonia and Helicobacter pylori can cause persistent infections of the respiratory and gastrointestinal
tract, respectively. It has been suggested that persistent infection of arteries with these bacteria can contribute to the
development of atherosclerosis and aneurysm. The aim of this study was to investigate the association between PCR
evidence of infection with C. pneumonia and H. pylori, and the occurrence of abdominal aortic aneurysm and atherosclerosis. Sixty patients; 30 with abdominal aortic aneurysm (mean age 67.4: 27 male, 3 female) and 30 with aortoiliac arteriosclerosis (mean age 58.5; 29 male, 1fe male) undergone surgery of the abdominal aorta for atherosclerotic obstructive lesions were the study group. Ten specimens from the macroscopically healthy regions of aortic
wall from cadaver were the control group. The presence of microorganism DNA in specimens was assessed by PCR.
Chlamydia Pneumonia DNA discovered in 47/60 (78.3%) of the study group cases in the wall of aorta and/or its
atheromatous plaque whereas none of them showed H. pylori DNA. The control group showed no detection of C.
Pneumonia DNA. The presence of C. pneumonia and H. pylori DNA in a considerable number of atherosclerotic
plaques but their absence in cadaver healthy vascular wall supports the idea that they may have a role in the development of atherosclerosis, especially in countries where infection is prevalent and where conventional risk factors
fail to explain the high prevalence of atherosclerotic vascular disease.
Abstract... Pigeon fancier`s lung (PFL) is a form of extrinsic allergic alveolitis (hypersensitivity pneumonitis) the pathogenesis
of the disease is throught to be caused by the deposition of immune complexes in the alveoli. Although this is generally agreed in the bionic pathogenesis of disease it is difficult to understand why a large proportion of people with
high titres of antibody do not get disease. Allergen avoidance to pigeon is the best therapy for Pigeon fancier`s lung
(PFL). However, allergen avoidance is not possible because of occupational exposure, immunotherapy may be the
treatment of choice in cases of pigeon allergy. In this study we firstly showed the optimal concentration of LPS and
the optimum time for activation was 10μ/ml for 24 hours after stimulated the cells by PMA for 72 hours. Immune
complexes were generated with mucin, fresh pigeon droppings (PDF), old pigeon droppings (PDO), and patents
sera. Immune complexes with PDF and PDO activated macrophages to produce TNFα. However immune complex
with mucin did not activate macrophages. There was difference in the ability of immune complexes from symptomatic and asymptomatic individual to activate macrophage.
Abstract... Pigeon fancier`s lung (PFL) is a form of extrinsic allergic alveolitis (hypersensitivity pneumonitis) the pathogenesis
of the disease is throught to be caused by the deposition of immune complexes in the alveoli. Although this is generally agreed in the bionic pathogenesis of disease it is difficult to understand why a large proportion of people with
high titres of antibody do not get disease. Allergen avoidance to pigeon is the best therapy for Pigeon fancier`s lung
(PFL). However, allergen avoidance is not possible because of occupational exposure, immunotherapy may be the
treatment of choice in cases of pigeon allergy. In this study we firstly showed the optimal concentration of LPS and
the optimum time for activation was 10μ/ml for 24 hours after stimulated the cells by PMA for 72 hours. Immune
complexes were generated with mucin, fresh pigeon droppings (PDF), old pigeon droppings (PDO), and patents
sera. Immune complexes with PDF and PDO activated macrophages to produce TNFα. However immune complex
with mucin did not activate macrophages. There was differen
Abstract... Alpha1 antitrypsin deficiency (α1ATD) is a genetic disorder that affects 1 in 1500-3000 of European origin population. Mutation in SERPINA1 gene appears to be the main cause of α1ATD.This disorder increases the risk of Chronic Obstructive Pulmonary Disease (COPD) due to the proteolytic action of serine proteases on the alveolar cells and
accumulation of α1AT consequent immune response. In addition, the effects of immune response to the accumulated enzyme in the Endoplasmic reticulum (ER). Patients aged 20-50 years having α1ATD are at a high risk for developing COPD. This review focuses on the molecular pathophysiology of α1ATD and how it leads to COPD. It is concluded that factors accelerating α1AT release in the peripheral circulation lead to a better outcome.