العدد السادس


A MODIFIED TECHNIQUE OF EXTERNAL DACRYOCYSTORHINOSTOMY
تاريخ النشر: 2017-06-30
Abdalla Alsidig Musa (Ophthalmology department, Faculty of medicine, Misurata University)
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امحمد أبوجلاله (- Internal Medicine Department, Misurata Central Hospital, Libya)
محمد حسين باتيل (Department of ENT Misrata Medical Center, Libya)
نجلاء البشير مهدو (Microbiology department, Gharian Medical University)
فتجي الأميل (Department of Pharmacology and Toxicology, Faculty of Pharmacy, Misurata University, Misurata, P.O. Box 2478, Libya)
حسين دياب (Department of Pharmaceutical Technology, Faculty of Medical Technology Misurata)
حسين العصودي (Department of Community Medicine, Faculty of Medicine, Misurata, Libya)
هبه الفناص (Department of surgery, Misurata cancer center, Misurata, Libya)
مصطفى عبدالناصر (Microbiology, Immunology & Infection Control Department, Faculty of Medicine, Al-Azhar University, Cairo, EGYPT)
محمد سويسي (Department of Ophthalmology, Faculty of medicine, University of Misurata, Libya)
خالد سالم بعيو (Department of ENT Misrata Medical Center, Libya)
محمد بن ساسي (Misurata University, Ophthalmology Department, Misurata-Libya)

Abstract... Chronic dacryocystitis usually occurs due to the obstruction of lacrimal passage at the junction of the lacrimal sac
and nasolacrimal duct. The reconstruction of lacrimal passages in such cases can be achieved by several surgical
techniques. We present a modified technique of external Dacryocystorhinostomy (DCR) by suturing of anterior
flaps and excision of the posterior flaps of the lacrimal sac and nasal mucosa and intubation. To present the outcome
of the modified technique of external DCR with anterior flap anastomosis, excision of posterior flaps and intubation.
The study included 30 patients with nasolacrimal duct obstruction who underwent the modified technique of external DCR with anastomosis of anterior flaps only, whereas the posterior flaps were excised. The success rate and
complications were recorded over a follow-up period of 6 months. In this study there was a female preponderance
with a male:female ratio of 1:2.75 The success rate of this modified technique was found to be 93.3%. Intraoperative
complications were bleeding in 13.3% and laceration of the nasal mucosa in 3.3% cases. Two patients had failed
DCR after 12 months. In 1 cases, the obstruction of the bony ostium by granulation tissue and in one case, the sump
syndrome was the cause of failure of DCR. This modified technique of external DCR only simplifies the surgical
procedure without compromising efficacy or safety of the procedure. Anterior flap DCR is a safe, easy to master and
effective surgical procedure.


Keywords : Chronic dacryocystitis, Dacryocystorhinostomy, Nasolacrimal duct obstruction

ROLE OF PATIENT AND FAMILY IN MITIGATING OUTBREAKS
تاريخ النشر: 2017-06-30

Abstract... In the past 20 years or more and until now many outbreaks attacked different areas all over the world. Most of them
have occurred in the developing countries. This review aims at highlighting the role of patient guided by epidemiologist and infection preventionist in combating outbreaks and pandemics. A pandemic is an epidemic (outbreak) occurring on a scale which crosses international boundaries, usually affecting a large number of people. a pandemic is
a global outbreak. Influenza, Middle East Respiratory syndrome coronavirus (MERS‐CoV), HIV/AIDS, Ebola,
Zika, Cholera, Polio are examples of these outbreaks. Wild aquatic birds are the natural hosts for a range
of influenza A viruses (e.g., H5N1, H5N8), occasionally, viruses are transmitted from these species to other species,
and may then cause outbreaks in domestic poultry and or rarely in humans. Since April 2012, MERS‐CoV have
been reported in Arabian Gulf countries especially the Kingdom of Saudi Arabia. The role camel is questionable
especially if we know that some cases have no history of contact to camel. AIDS is currently a pandemic, with infection rates as high as 25% in southern and eastern Africa. Effective national education about safer sexual practices
and blood borne infection precautions training have helped to slow down infection rates in several African countries.
Ebola had emerged in three West African Countries namely Guinea, Sierra Leone and Libra to spread to other
neighboring countries. The close contact of patient and his family with the infected vector (fruit bat or monkey),
beside the limited infrastructure in healthcare facilities increased the contiguity of the serious illness or even death.
On Feb. 1, 2016, the WHO declared "the cluster of microcephaly cases and other neurological disorders a health
emergency" and called for concerted efforts to curb the spread of Zika (the mosquito-borne virus Zika). Knowing
the hazards and how to protect yourself and your patient is the key to patient safety. Standard precautions (SP) are
the most effective means of preventing transmission of outbreaks and some other infections as multidrug resistant
bacteria. These include hand hygiene (HH), personal protective equipments (PPEs, as gloves, masks, googles, caps,
and gowns), cough etiquette, environmental cleaning and sharps management. International health authorities such
as WHO and national healthcare facilities are now prepared to involve patient / family in IPC measures including
HH, PPEs, environmental cleaning, waste disposal, etc. Posters, brushers, YouTube, Facebook and other social media will help in teaching patient the route of transmission, precautions against infection, his right to ask HCWs to
wash their hands and/or to wear PPEs. Last but not least patient / family and visitor have an active role in mitigating
the spread of these outbreaks in hospital, at home and community during, after or even before their spread. They
should be alert and listen carefully to the instruction of their doctor and nurse. They should also recognize that HH
is the most effective tool in preventing the spread of most infections and to wear PPEs gloves or mask when in need.
Their cooperation in keeping an environment clean and safe will also help preventing outbreaks.


Keywords : Patient, Family, Outbreaks, Influenza, (MERS‐CoV), AIDS, Ebola, Zika.

THE E-CADHERIN ADHESION MOLECULE STUDY IN LIBYAN PATIENTS WITH COLORECTAL CANCER
تاريخ النشر: 2017-06-30

Abstract... Colorectal cancer (CRC) is a major cause of cancer-related death worldwide. As tumor-node-metastasis staging system still remains the gold standard assessment of CRC patient`s prognosis, but it is no longer sufficient. E-cadherin
is one of the most important adhesive molecules involved in colorectal tumor growth, cell proliferation and progression. The aim of study is to investigate E-cadherin expression and evaluate its prognostic value in Libyan colorectal
cancer cases. Sixty Libyan patients with colorectal cancer diagnosed between 2004-2012 in Misurata cancer center
and Zliten central hospital were retrospectively studied. E-cadherin expression was detected by immunohistochemical staining of paraffin blocks using the automatic system, focused on the membranous staining pattern and two categories were applied, negative or positive. E-cadherin expression was significantly correlate with the tumor location
where the colon tumor expresses E-cadherin more than in the rectal ones. Lymph nodes metastasis is more frequently detected in tumors that showed loss of E-cadherin expression. There is significant association in this current study
between loss of E-cadherin expression and increase recurrence rate and distant metastases of the tumor. Clinical
variables as age, gender or tumor grade showed no significant association with E-cadherin expression. Investigation
of E-cadherin expression and distribution in colorectal tumors is extremely valuable for the prediction of outcomes
and rate of recurrence. These data may help to improve decisions concerning the therapy and management of colorectal cancer patients.


Keywords : Colorectal Cancer, E-Cadherin, Metastasis, Recurrence Rate.

SELF MEDICATION WITH ANTIBIOTICS IN MISURATA CITY, LIBYA
تاريخ النشر: 2017-06-30

Abstract... Self-medication with antibiotics is one form of antibiotic misuse which enhances the development of antibiotic resistance. Antibiotic resistance is a worldwide public health problem which leads to treatment failures causing deaths
and an increase in health care costs. A study was conducted to estimate the prevalence of self medication with antibiotics among adults in Misurata city, Libya and to identify factors associated with antibiotic self medication. A
descriptive cross sectional study was carried out at outpatient clinics of Misurata Central Hospital. 277 Adults were
included in the study. Data were collected using a pre-designed, structured interviewing questionnaire and analyzed
using SPSS version 20. 64 (39.5%) of 162 antibiotic users identified via the study had used antibiotics without a
prescription within a six months before the study period. Male participants using antibiotics as self medication
(51.5%) was higher than females (31.2%). The main reason for self medication as reported by the participants was
minor illness and do not worth consultation of physician. Private pharmacies were the main source of nonprescribed antibiotics (70.6%) and about 47% of participants purchased the antibiotics in consultation with a pharmacist. The antibiotics most frequently used in self medication were Amoxicillin-Clavulanate (54.8%) followed by
Amoxicillin (25.8%). Respiratory problems such as common cold (49.4%) were the main indication for selfmedication with antibiotics. The prevalence of self-medication with antibiotics in Misurata city is alarmingly high.
Effective strategies involving regulatory enforcement prohibiting sales of antibiotics without prescription should be
implemented along with educational interventions for health professionals and the public.


Keywords : Self medication, Antibiotics, Resistant bacteria, Misurata, Libya

EPIDEMIOLOGY OF ACUTE POISONING IN CHILDREN: SIX YEARS RETROSPECTIVE STUDY IN THE PEDIATRIC DEPARTMENT AT MISURATA MEDICAL CENTER-LIBYA FROM 2012-2017
تاريخ النشر: 2017-06-30

Abstract... This descriptive retrospective study was conducted to shed light on acute children poisoning attending pediatric department at Misurata Medical Center (MMC)-Libya. The study conducted for six years period to evaluate epidemiology, to determine etiologies, to find relation between child poisoning with age, sex and seasons and to present the
change over the years of study. This study conducted on 161 children admitted because of poisoning. Data collected
from patient`s files in the documentation unit of the MMC. All the children aged from three days to thirteen years of
age, admitted due to acute intoxication over a period of six years studied carefully. A total of 161 (1.06 %) of total
pediatric admissions, with history of Acute poisoning (AP( included in the study. All cases of AP unintentional.
Majority of patients (67.08%) were male. Male/Female ratio 2.05: 1.00. Age group 1-5 years had the highest
117(72.67%) frequency of admission due to AP. Medications were the most common causes of AP 48(29.81%),
followed by food poisoning 27(16.77%). pesticides 23(14.28%), caustic cleaning agents 15(9.31%), plants
13(8.07%), and kerosene 9(5.59%). The most common medicines responsible for the AP were paracetamol
11(22.91%) and metoclopramide 6(12.50%). The highest rate of children`s admission due to poisoning was in the
Autumn 52(32.98%). Children are curious, and explore everything with their hands, mouths and all senses. AP was
unintentional in all cases and most of children were discharged in a good clinical condition after a short period of
hospitalization and there was no mortality recorded through the period of study. AP may be drug over dose or as
iatrogenic, contaminated food, pesticide, chemical agent, gas, plant and animal in nature. There were an inverse proportion between the age of children and the number of poisoning. AP can be prevented or minimized by adequate
supervision of the child, proper storage of medications and household products, increasing public awareness, counseling and correct guidance to the parents and early referral to the hospital.


Keywords : Acute poisoning, Children, Misurata Medical Center

MANUAL SMALL-INCISION CATARACT SURGERY: OUTCOME AND COMPLICATIONS
تاريخ النشر: 2017-06-30

Abstract... Cataract is the primary cause of avoidable blindness worldwide, while age-related cataract is the most common and
cataract surgery forms the major workload of most ophthalmic units. Manual small incision cataract surgery (MSICS)
has become popular in Libya in the last few years. It is significantly faster, less expensive, require less technology and
achieves excellent visual outcomes with low complication rates. The aim of the study is to evaluate the safety, complications and outcome of MSICS in the treatment of patients with mature cataract. Data was collected from medical
records of 190 eyes of 184 patients with mature cataract that received surgery at Albasar ophthalmology clinic and
Misurata central hospital- Misurata-Libya between January 2014 and December 2017. Out of 184 patients 109 were
females (59.2%) and 75 were males (40.8%). About 74% of the patients were between 51 and 70 years old. Intraoperative difficulties and complications encountered during surgery were improper tunnel construction inform of premature entry in two (1.05%) cases and button holing in one (0.52%) case. Difficulty in nucleus delivery to anterior
chamber 13 (6.8%) cases, pupillary constriction 10 (5.3%) cases, intraoperative hyphema 13 (6.8%) cases, capsulorrhexis extension and posterior capsular tear with vitreous loss 4 (2.1%) cases, iris prolapse 2 (1.05%) cases. Widening of the incision to facilitate nucleus delivery in 19 (10%) cases. The postoperative complications include hyphema 9 (4.7%) cases, transient corneal oedema 42 (22.1%) cases, corneal decompensation one (0.5%) case. Irregular
pupil 13 (6.8%) cases, iritis 11 (5.8%) cases and posterior capsule opacification (PCO) 3 (1.6%) cases. The recorded
best corrected visual acuity (BCVA) three months postoperative was good results (visual acuity 6/12 or better), the
average results (visual acuity between 6/18 and 6/60) and the poor results (visual acuity less than 6/60) were respectively 82.1%, 12.6% and 5.3%. MSICS can be recommended as an efficacious surgical technique with low complications and good visual outcome in treatment of patients with mature cataract.


Keywords : Cataract, manual small incision cataract surgery, intraoperative, postoperative complications, capsulorrhexis, hyphema.

SURVEY OF PATHOGENIC BACTERIA IN NEONATAL INTENSIVE-CARE UNIT OF TRIPOLI MEDICAL CENTER 2013
تاريخ النشر: 2017-06-30

Abstract... the neonatal intensive care unit is an ideal environment for transmission of many pathogens, which lead to high
morbidity and mortality in those age group. also these microorganisms causing nosocomial infection because of
their high resistance to many antibiotics which lead to economic burdens, in addition to social and psychological
factors affecting the families due to long duration in hospitals. prevention of infection requires the identification of
contaminated equipment, education regarding infection control method including hand washing and judicious of
antimicrobial agents. Three months (may, June, and July 2013) period fellow up for all neonates who admitted to
intensive care unit (244 neonate from NICU and 235 neonates from SCBUat Tripoli medical center and have pathogenic organisms where isolated and identified according to the stander microbiological method , microbial susceptibility and antimicrobial resistant pattern where determined against various antibiotics. From one hand the most
frequent organisms recovered are klepsilla pneumonia (32.67% and 30.76%) and acinetobacter bumani (39.60% and
47.69%) for NICU and SCBU, respectively. on the other hand, the less frequent organisms are staph haemolyticus
(8.91% nicu) (4.62% scbu), staph hominis (6.93% NICU) (3.07% SCBU), E.coli (4.95% NICU) (9.23% SCBU).
Enterococcus spp (6.93% NICU),( 4.62% SCBU)the main source of infection ,blood (10.5% NICU) (11.76%
SCBU), ETT (52.5% NICU) (58.33% SCBU),vein catheter (28.57% NICU) umbilical swab (7.33% NICU)
(17.67%SCBU) , nasal swab (3.53%NICU)(12%SCBU) eye swab (30%NICU) (46.76%SCBU) skin swab, (30%
NICU) (26.76% SCBU) rectal swab (3.75% NICU) (10.77% SCBU), CSF (33.35% NICU ) (3.85% SCBU) urine
catheter (30.33 NICU) (26.76% SCBU). Data indicate significant infection problem in Tripoli Medical Center Hospital, and inefficient infection control programs, The gram negative bacteria especially acinetobacter bumanii and
klebsilla pneumonia were the predominant cause of neonatal infection.


Keywords : : Pathogenic, Bacteria, Neonates, Antibiotic Resistance, Intensive Care Unit.

EVALUATION OF ADENOIDAL HYPERTROPHY BY LATERAL PLAIN X-RAY NASOPHARYNX: IN ENDOSCOPY ERA
تاريخ النشر: 2017-06-30

Abstract... Adenoid, the hyperplasia of nasopharyngeal lymphoid tissue is one of the main cause of nasal obstruction and mouth
breathing in school age children and also leading to snoring and nasal obstruction. Accurate diagnosis of this alteration
is important for proper therapeutic planning. Accurate assessment of adenoid size and its relationship to post nasal
space is difficult to achieve clinically which can be misleading when a decision for adenoidectomy has to be taken. It
is common practice to request for lateral radiograph for post nasal space to visualize enlarged adenoid when adenoidal
hypertrophy is suspected in child with upper air way obstruction. Recently with introduction of nasal endoscope has
made the examination of nasal cavity and nasopharynx in children possible and considered to be gold standard but
has disadvantage of invasive procedure. The aim of this study is to evaluate the reliability of X-ray in diagnosis of
adenoid hypertrophy and to validate this with endoscopy of nasopharynx in evaluation of adenoid size. This is a
prospective study conducted in E.N.T. department at Misrata Medical Center, of one year duration from June 2015 to
May 2016 included 77 patients admitted for adenoidectomy of age group ranging from 1.3 years to 15 years with
symptoms of upper air way obstruction had a standard lateral soft tissue neck X-ray and rigid endoscopic examination
of nasopharynx to evaluate adenoid size, and size was graded independently. The variable of both procedures were
scored and the agreement between two methods assessed using weighted kappa statistics. Adenoidal hypertrophy
according to plain X-ray of naso pharynx 41patients (53.24%) had adenoid grade III (commonest grade). According
to endoscopic assessment the commonest grade of adenoid size was grade III seen in 53 patients(68.83%) and Numerical score to determine each size of adenoid in increasing level in which 1 point was credit to small adenoid,
2 point for medium adenoid and 3 point for large adenoid. Mean score for average size of adenoid in a scale 1-3 score
it was 1.81 on X-ray while through endoscopy was 2.12, It indicates that endoscopy is more reliable than X-ray to
assess the size and shape of adenoid. Out of 77 patients in this study, 40 of them had complete correlation between Xray and endoscopic findings. The observed agreement is 40/77(51.95 % of observation) on linear weighted kappa =
0.209, is a fair agreement between these findings. The study revealed that result of X-ray has tendency to under estimate the size of adenoid. Evaluation by endoscopy was more accurate than evaluation by X-ray, though the result is
not statistically significant (the chi square statistics is 9, 3871 (p- value is 0.05212,) using pearson`s chi square at .05
level of significance. Evaluation by endoscope was more accurate than evaluation by X-ray. Hence, the children with
symptoms of nasal obstruction even adenoid hypertrophy not revealed on X-ray suggested to be submitted to nasoendoscopy for diagnostic accuracy, which is very relevant for indication of adenoidectomy.


Keywords : X-ray nasopharynx, adenoid hypertrophy, endoscopic nasopharynx assessment.

USE AND MISUSE OF ANTIBIOTICS IN DIFFERENT MEDICAL DEPARTMENTS IN MISURATA CENTRAL HOSPITAL
تاريخ النشر: 2017-06-30

Abstract... The pattern of antibiotics use in hospital settings has been linked to the rising threat of antibiotic resistance. There
are established global efforts to encourage reporting of antibiotic consumption in hospital settings. Unfortunately,
those studies of antibiotic consumption levels on our national level are limited. So the aim of this study was to track
levels of antibiotic consumption in different medical departments in Misurata Central Hospital during December
2016 in order to identify and report any potential evidence of antibiotics misuse. A retrospective cross sectional
study was conducted in 2017 using data from patient files who were admitted to Misurata Central Hospital in December 2016 in 12 different departments. 1001 patient`s files were reviewed and data was analyzed. The antibiotic
use rate expressed as days of therapy per 1000 patient days (DOT/1000PD). The patients were categorized into two
groups; group with risk factors for Multi-Drug Resistant bacteria "MDR"305 (30.46%) and the other has no risk
factor (69.54%). More than half of the admitted patients received antibiotics during their hospital stay, 649
(64.84%), and about two third of the risky group patients received antibiotics, 181 (59.34%). Culture and Sensitivity
was only ordered for 11 patients (6.07%). The rate of antibiotic use expressed as days of therapy per 1000 patient
days (DOT/1000PD) was 1,487. Most of the admitted patients received antibiotics, and most of them had no Culture
and Sensitivity orders. The overall usage of antibiotics exceeds the mean of 855 DOT/1000PD reported in a study
from USA capturing aggregate data using electronic claim from different wards. We recommend the implementation
of Antibiotics Stewardship Programs “ASP” inside the hospital to establish a policy of antibiotic prescription to different kind of patients in order to decrease the antibiotic misuse and to prevent the development of antibiotic resistance.


Keywords : : Antibiotics use; Misuse; Inpatients; Days of therapy; Misurata; Hospital.

INVESTIGATION OF THE PHYTOCHEMICAL COMPOSITION AND HEPATOPROTECTIVE EFFECT OF LEUCANTHEMOPSIS TRIFURCATUM GROWING IN LIBYA
تاريخ النشر: 2017-06-30

Abstract... Leucanthemopsis trifurcatum is common to Mediterranean countries and widely used in traditional medicine especially for north African countries. Due to the scarcity of researches about the pharmacological activities of L. trifurcatum, we intended to screen the L. trifurcatum ethanolic extract (LEE) for hepatoprotective effects against paracetamol induced chronic toxicity. LEE is subjected to preliminary phytochemical and pharmacological screening.
Hepatotoxicity is induced in rats by chronic oral administration of paracetamol (PCM) for 30 days. LEE ( 300 and
500 mg/kg), and silymarin (25 mg/kg) were administered orally, for 30 days, along with PCM to explore their hepatoprotective activities. Phytochemically, LEE revealed the presence of alkaloids, carbohydrates, and flavonoids as
well as nine separated spots on TLC paper using toluene : ethyl acetate: formic acid (5:4:1) solvent system. The
treatment with LEE (300 and 500 mg/kg, p.o.) caused hepatoprotective activity in a dose dependent manner through
significant reduction of liver enzymes (AST, ALT, and ALP) compared to paracetamol toxicity. 500 mg/kg of LEE
exerted a profound hepatoprotective action comparable to silymarine. This activity may be attributed to the synergistic action between the phytochemical constituents of LEE.


Keywords : : Leucanthemopsis trifurcatum, antinflammatory, hepatoprotective, analgesic, anticonvulsant, phytoconstituents