Purpose: Investigation of the crystallinity of salbutamol sulfate a model drug used in the dry powder inhalation formulation. Materials and Methods: Salbutamol sulfate was supplied kindly by Lindopharm (Hilden, Germany). Salbutamol sulfate was milled using an air jet milling process, the particle size and morphology were determined using laser diffraction and the scanning electron microscopy. The drug was subjected to conditioning through storage at 52.8% and 75% relative humidity for 24 h, 1 week, and 2 weeks, respectively. The drug crystallinity was investigated using differential scanning calorimetry (DSC), X-ray diffraction, and water vapor sorption techniques. Results and Discussion: Conditioning of salbutamol sulfate after micronization lowers the glass transition (Tg) temperature of the amorphous parts present at particle surface, which enhances particle mobility for more rearrangement associated with water expelling. This transformation may result in deviation from the original particle size obtained after milling out of respirable range. DSC and X-ray diffraction show no detectable amorphous drug since no detectable Tg observed. Alternatively, water vapor sorption shows a small amount of amorphous salbutamol sulfate at the particle surface, which recrystallizes at 52.8% relative humidity after approximately 2 weeks of conditioning. Conclusion: The amorphous regions can be generated in crystalline materials during processing. The level of amorphous materials can affect every step of pharmaceutical formulation, storage, and stability. However, quantification of low levels of amorphous content still poses considerable challenge. This study confirms that, the water vapor sorption technique is useful in the quantification of a small amount of drug amorphous content.
{"title":"Influence of micronization on the physical properties of salbutamol sulfate as a model drug used in dry powder inhalation","authors":"Antesar M. Boshhiha, N. Urbanetz","doi":"10.4103/LIUJ.LIUJ_4_18","DOIUrl":"https://doi.org/10.4103/LIUJ.LIUJ_4_18","url":null,"abstract":"Purpose: Investigation of the crystallinity of salbutamol sulfate a model drug used in the dry powder inhalation formulation. Materials and Methods: Salbutamol sulfate was supplied kindly by Lindopharm (Hilden, Germany). Salbutamol sulfate was milled using an air jet milling process, the particle size and morphology were determined using laser diffraction and the scanning electron microscopy. The drug was subjected to conditioning through storage at 52.8% and 75% relative humidity for 24 h, 1 week, and 2 weeks, respectively. The drug crystallinity was investigated using differential scanning calorimetry (DSC), X-ray diffraction, and water vapor sorption techniques. Results and Discussion: Conditioning of salbutamol sulfate after micronization lowers the glass transition (Tg) temperature of the amorphous parts present at particle surface, which enhances particle mobility for more rearrangement associated with water expelling. This transformation may result in deviation from the original particle size obtained after milling out of respirable range. DSC and X-ray diffraction show no detectable amorphous drug since no detectable Tg observed. Alternatively, water vapor sorption shows a small amount of amorphous salbutamol sulfate at the particle surface, which recrystallizes at 52.8% relative humidity after approximately 2 weeks of conditioning. Conclusion: The amorphous regions can be generated in crystalline materials during processing. The level of amorphous materials can affect every step of pharmaceutical formulation, storage, and stability. However, quantification of low levels of amorphous content still poses considerable challenge. This study confirms that, the water vapor sorption technique is useful in the quantification of a small amount of drug amorphous content.","PeriodicalId":18106,"journal":{"name":"Libyan International Medical University Journal","volume":"42 1","pages":"8 - 15"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88933635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: The aim of this study was to evaluate the efficacy and outcome of sutureless and glue-free conjunctival autograft for the management of primary pterygium in terms of complications such as loss of graft, graft dehiscence, and recurrence rate. Materials and Methods: A case series study was carried out in March 2015 at Nastaein private sanatorium, Zlitin, Libya. Twenty-seven eyes of 23 patients with primary pterygium were included in this study. Pterygium excision with conjunctival autografting without using sutures or glue was done to all patients. The patients were followed up postoperatively after 1 h, 1st day postoperatively, and then 1 week, 4 weeks, 3 months, 6 months, and 12 months. Results: The mean age of the patients was 55.9 ± 8.55 years (range: 43–71 years); 65% were male. Mean follow-up time was 10.2 ± 2 months. Changes of visual acuity were not noticed in any of these patients. Only one patient (3.7%) developed edge recession of the graft on the 1st postoperative day due to a wrong measurement of the size of the graft, and no other complications were noted. Cosmesis was excellent in all cases and no recurrence was noted. Conclusions: Sutureless and glue-free conjunctival autograft for primary pterygium surgery is a safe and effective way for the management of primary pterygium.
{"title":"Sutureless and glue-free conjunctival autograft for pterygium surgery: A preliminary report about Libyan experience","authors":"Naeima M Elzlitni, Sabah S Eldressi, S. Bukhatwa","doi":"10.4103/LIUJ.LIUJ_8_18","DOIUrl":"https://doi.org/10.4103/LIUJ.LIUJ_8_18","url":null,"abstract":"Aim: The aim of this study was to evaluate the efficacy and outcome of sutureless and glue-free conjunctival autograft for the management of primary pterygium in terms of complications such as loss of graft, graft dehiscence, and recurrence rate. Materials and Methods: A case series study was carried out in March 2015 at Nastaein private sanatorium, Zlitin, Libya. Twenty-seven eyes of 23 patients with primary pterygium were included in this study. Pterygium excision with conjunctival autografting without using sutures or glue was done to all patients. The patients were followed up postoperatively after 1 h, 1st day postoperatively, and then 1 week, 4 weeks, 3 months, 6 months, and 12 months. Results: The mean age of the patients was 55.9 ± 8.55 years (range: 43–71 years); 65% were male. Mean follow-up time was 10.2 ± 2 months. Changes of visual acuity were not noticed in any of these patients. Only one patient (3.7%) developed edge recession of the graft on the 1st postoperative day due to a wrong measurement of the size of the graft, and no other complications were noted. Cosmesis was excellent in all cases and no recurrence was noted. Conclusions: Sutureless and glue-free conjunctival autograft for primary pterygium surgery is a safe and effective way for the management of primary pterygium.","PeriodicalId":18106,"journal":{"name":"Libyan International Medical University Journal","volume":"73 1","pages":"16 - 19"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83963203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-01DOI: 10.21502/LIMUJ.019.02.2017
B. Mhana, J. Mezogi, M. El-Majri, A. Abushoffa
Objectives: This study aims to evaluate a novel tablet excipient obtained from local sources, Pearl millet Pannistumamericanum starch of family Poaceae which is used locally as food because of its high carbohydrate content. It was thought that the starch of Pearl millet Pannistumamericanum may serve as a tablet disintegrant. Methods: The excipient properties of Pearl millet starch as well as the pregelatinized form were studied in paracetamol tablets produced by wet and dry granulation methods of massing and screening and compared with maize starch BP. Results: Wet method showed superiority in all properties of both granules and tablets. Using wet method granulations Pearl millet Pannistumamericanum starch and maize starch BP have similar angle of repose, Carr′s index, tapped density, bulk density, and Hausner′s ratio, however, Pearl millet Pannistumamericanum starch has shown advantageous in some properties such as moisture content and swelling index. Tablet produced with Pearl millet Pannistumamericanum starch disintegrated almost the same of those produced with maize starch BP at all concentrations employed. It was also found that when used as a disintegrant, the pre-gelatinized form provide tablets with better hardness and friability values than maize starch BP. Conclusion: This study confirmed the suitability of Pearl millet Pannistumamericanum starch as an alternative to maize starch BP as a tablet disintegrant, particularly, in paracetamol tablet formulation.
{"title":"Evaluation of pearl millet starch as tablet disintegrant","authors":"B. Mhana, J. Mezogi, M. El-Majri, A. Abushoffa","doi":"10.21502/LIMUJ.019.02.2017","DOIUrl":"https://doi.org/10.21502/LIMUJ.019.02.2017","url":null,"abstract":"Objectives: This study aims to evaluate a novel tablet excipient obtained from local sources, Pearl millet Pannistumamericanum starch of family Poaceae which is used locally as food because of its high carbohydrate content. It was thought that the starch of Pearl millet Pannistumamericanum may serve as a tablet disintegrant. Methods: The excipient properties of Pearl millet starch as well as the pregelatinized form were studied in paracetamol tablets produced by wet and dry granulation methods of massing and screening and compared with maize starch BP. Results: Wet method showed superiority in all properties of both granules and tablets. Using wet method granulations Pearl millet Pannistumamericanum starch and maize starch BP have similar angle of repose, Carr′s index, tapped density, bulk density, and Hausner′s ratio, however, Pearl millet Pannistumamericanum starch has shown advantageous in some properties such as moisture content and swelling index. Tablet produced with Pearl millet Pannistumamericanum starch disintegrated almost the same of those produced with maize starch BP at all concentrations employed. It was also found that when used as a disintegrant, the pre-gelatinized form provide tablets with better hardness and friability values than maize starch BP. Conclusion: This study confirmed the suitability of Pearl millet Pannistumamericanum starch as an alternative to maize starch BP as a tablet disintegrant, particularly, in paracetamol tablet formulation.","PeriodicalId":18106,"journal":{"name":"Libyan International Medical University Journal","volume":"68 1","pages":"152 - 163"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86718018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-01DOI: 10.21502/LIMUJ.015.02.2017
A. Etabbal, Omar A. El Tarhuni, Ashraf F. Trhawi
BACKGROUND: Undescended testis (UDT) is the failure of testes to descend into the scrotum. It is classified according to the site of arrest into; Intra-abdominal, deep inguinal ring, canalicular, or emergent from the superficial inguinal ring. The diagnosis of UDT is mainly clinical and its treatment is usually surgical. The aim of our study is to analyze age distribution at the time of diagnosis and treatment to determine if the international guideline recommendations are followed in our institution or not. PATIENTS & METHODS: A retrospective study was carried at Urological Center by reviewing the files of 75 consecutive patients admitted to the hospital in the period from July 2011 to April 2014. A data flow sheet was used to record and analyze the patients' personal data, age at diagnosis, physical findings, type of surgical procedure, and the age of the patients at the time of surgery, as well as surgical findings. RESULTS: Total number of patients enrolled in the study was 75 patients. Fifty-two cases were diagnosed at birth, 14 cases discovered incidentally, and 9 cases were presented with reducible inguinal swelling with or without pain. The 75 patients had 93 UDTs, 49 UDTs on right side and 44 UDTs on left side. Sixty-nine UDTs were clinically palpable while the other 24 UDTs were not palpable (74.2% and 25.8% respectively). The mean age at the time of diagnosis was 3.7 ± 8.3 years. However, the mean age at the time of surgery was 10.8 ± 10 years. The surgical procedures performed were: orchiopexy (n=58, 62.3 %,), orchiopexy combined with ipsilateral hernial repair (n=16, 17.2%) and orchiectomy (n=19, 20.4%). CONCLUSION: In our institution, the mean age at orchiopexy was significantly delayed beyond the recommended time of surgery because of delayed diagnosis or referral.
{"title":"Undescended testis: timing of referral and surgical intervention, Urology Center, Benghazi, Libya","authors":"A. Etabbal, Omar A. El Tarhuni, Ashraf F. Trhawi","doi":"10.21502/LIMUJ.015.02.2017","DOIUrl":"https://doi.org/10.21502/LIMUJ.015.02.2017","url":null,"abstract":"BACKGROUND: Undescended testis (UDT) is the failure of testes to descend into the scrotum. It is classified according to the site of arrest into; Intra-abdominal, deep inguinal ring, canalicular, or emergent from the superficial inguinal ring. The diagnosis of UDT is mainly clinical and its treatment is usually surgical. The aim of our study is to analyze age distribution at the time of diagnosis and treatment to determine if the international guideline recommendations are followed in our institution or not. PATIENTS & METHODS: A retrospective study was carried at Urological Center by reviewing the files of 75 consecutive patients admitted to the hospital in the period from July 2011 to April 2014. A data flow sheet was used to record and analyze the patients' personal data, age at diagnosis, physical findings, type of surgical procedure, and the age of the patients at the time of surgery, as well as surgical findings. RESULTS: Total number of patients enrolled in the study was 75 patients. Fifty-two cases were diagnosed at birth, 14 cases discovered incidentally, and 9 cases were presented with reducible inguinal swelling with or without pain. The 75 patients had 93 UDTs, 49 UDTs on right side and 44 UDTs on left side. Sixty-nine UDTs were clinically palpable while the other 24 UDTs were not palpable (74.2% and 25.8% respectively). The mean age at the time of diagnosis was 3.7 ± 8.3 years. However, the mean age at the time of surgery was 10.8 ± 10 years. The surgical procedures performed were: orchiopexy (n=58, 62.3 %,), orchiopexy combined with ipsilateral hernial repair (n=16, 17.2%) and orchiectomy (n=19, 20.4%). CONCLUSION: In our institution, the mean age at orchiopexy was significantly delayed beyond the recommended time of surgery because of delayed diagnosis or referral.","PeriodicalId":18106,"journal":{"name":"Libyan International Medical University Journal","volume":"2 1","pages":"120 - 127"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89965040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-01DOI: 10.21502/LIMUJ.012.02.2017
Fatma Elsheikhi, I. Bugaighis, T. Hamed
Background: Orthodontists need to evaluate intermaxillary tooth size discrepancy (TSD) prior to initiating treatment in order to achieve a stable treatment. Thus, the aim of the present study was to determine the prevalence of TSD in Libyan subjects among different malocclusion groups. Methods: A sample of 60 dental casts of Libyan subjects with different types of malocclusions (Class I, Class II div 1 and Class III) were included in the study. Each malocclusion group (20 dental casts) included equal numbers of males and females, 12-17 years of age. Mesio-Distal tooth measurements were extracted to compute the anterior and overall TSD ratios. Paired Student t-test was used to detect significant discrepancies between the paired teeth measurements. Analysis of Variance (ANOVA) and Tukey Honestly tests were undertaken to detect significant discrepancies among the malocclusion groups. Results: Paired t-test revealed that there were no significant discrepancies between the paired tooth widths except for the upper first molars, upper first premolars, lower lateral incisors and lower canines (P<0.010). ANOVA found no significant differences in the mean anterior TSD ratio in regard to malocclusion groups. However, a significant disparity was noticed in the mean overall TSD ratio among the different malocclusion categories (P<0.04). Conclusion: Statistically significant TSD between the examined malocclusion groups were observed only in the mean overall TSD ratio.
{"title":"Tooth size discrepancy in different malocclusion groups in Libya: a pilot study","authors":"Fatma Elsheikhi, I. Bugaighis, T. Hamed","doi":"10.21502/LIMUJ.012.02.2017","DOIUrl":"https://doi.org/10.21502/LIMUJ.012.02.2017","url":null,"abstract":"Background: Orthodontists need to evaluate intermaxillary tooth size discrepancy (TSD) prior to initiating treatment in order to achieve a stable treatment. Thus, the aim of the present study was to determine the prevalence of TSD in Libyan subjects among different malocclusion groups. Methods: A sample of 60 dental casts of Libyan subjects with different types of malocclusions (Class I, Class II div 1 and Class III) were included in the study. Each malocclusion group (20 dental casts) included equal numbers of males and females, 12-17 years of age. Mesio-Distal tooth measurements were extracted to compute the anterior and overall TSD ratios. Paired Student t-test was used to detect significant discrepancies between the paired teeth measurements. Analysis of Variance (ANOVA) and Tukey Honestly tests were undertaken to detect significant discrepancies among the malocclusion groups. Results: Paired t-test revealed that there were no significant discrepancies between the paired tooth widths except for the upper first molars, upper first premolars, lower lateral incisors and lower canines (P<0.010). ANOVA found no significant differences in the mean anterior TSD ratio in regard to malocclusion groups. However, a significant disparity was noticed in the mean overall TSD ratio among the different malocclusion categories (P<0.04). Conclusion: Statistically significant TSD between the examined malocclusion groups were observed only in the mean overall TSD ratio.","PeriodicalId":18106,"journal":{"name":"Libyan International Medical University Journal","volume":"32 1","pages":"92 - 100"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89585003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-01DOI: 10.21502/limuj.013.02.2017
L. Abdulmalek
BACKGROUND: This study intended to assess knowledge, attitudes, and practices regarding standard precautions concerning health care-associated infections (HAIs) among hemodialysis nurses in hemodialysis centers in Benghazi. METHODS: the study was a cross sectional study carried out during the period from 1-3-2014 till 30-9-2014. The data was gathered from hemodialysis nurses in hemodialysis centers in Benghazi by using a questionnaire and by direct interview. RESULTS: There were a total of 59 hemodialysis nurses in hemodialysis centers in Benghazi. All agreed to participate in the study. Although 92% of the nurses knew that their hands could be a source of health care-associated infections, but only 52% of nurses washed their hands before contacting another patient. Gloves were actually used by 98% of the nurses. 46% of the nurses were usually wearing masks when contacting a patient. Books and journals were the main source of information about (HAI) among 52% of the nurses. CONCLUSION: The nurses' knowledge of health care-associated infections did not modify their adherence to hand hygiene practices. This study recommend training programs for hemodialysis nurses about promoting higher hand hygiene standards and potential use of personal protective measures during their shifts in hemodialyais centers.
{"title":"Knowledge, attitudes and practices of personal protective measures among hemodialysis nurses in Benghazi","authors":"L. Abdulmalek","doi":"10.21502/limuj.013.02.2017","DOIUrl":"https://doi.org/10.21502/limuj.013.02.2017","url":null,"abstract":"BACKGROUND: This study intended to assess knowledge, attitudes, and practices regarding standard precautions concerning health care-associated infections (HAIs) among hemodialysis nurses in hemodialysis centers in Benghazi. METHODS: the study was a cross sectional study carried out during the period from 1-3-2014 till 30-9-2014. The data was gathered from hemodialysis nurses in hemodialysis centers in Benghazi by using a questionnaire and by direct interview. RESULTS: There were a total of 59 hemodialysis nurses in hemodialysis centers in Benghazi. All agreed to participate in the study. Although 92% of the nurses knew that their hands could be a source of health care-associated infections, but only 52% of nurses washed their hands before contacting another patient. Gloves were actually used by 98% of the nurses. 46% of the nurses were usually wearing masks when contacting a patient. Books and journals were the main source of information about (HAI) among 52% of the nurses. CONCLUSION: The nurses' knowledge of health care-associated infections did not modify their adherence to hand hygiene practices. This study recommend training programs for hemodialysis nurses about promoting higher hand hygiene standards and potential use of personal protective measures during their shifts in hemodialyais centers.","PeriodicalId":18106,"journal":{"name":"Libyan International Medical University Journal","volume":"26 1","pages":"101 - 111"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72934635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-01DOI: 10.21502/LIMUJ.018.02.2017
G. Ashour, W. Said
Objectives: This study, aimed to evaluate the expression of COX-2 in renal cell carcinoma, and correlate it with different patient clinicopathological data, emphasizing on the role of COX-2 as a prognostic factor for renal cell carcinoma and to decide which cases more likely benefit from the targeted therapy later on. Patients and Methods: The present series consisted of tissue samples obtained from 47 patients (30 patients were males and 17 were females). All the tumor samples were collected from the Pathology Department, Faculty of Medicine, Alexandria University during the period from July 2009 to November 2010. Archival paraffin-embedded renal cell carcinoma tissue samples were used to prepare tissue microarray blocks for immunohistochemical staining with COX-2 antibody. Marker expression was categorized for statistical analysis then correlated to clinicopathological variables. Results: The histological types was significantly associated with COX-2 expression, with higher expression being more common in papillary and chromophobe renal cell carcinoma, the majority of these two types were in score 1 and 2 while majority of clear cell renal cell carcinoma had score 0 and 1. Conclusion: The association of COX-2 marker was related to the histologic type of tumor; COX-2 expression study might provide prognostic information regarding tumor aggressiveness. These findings suggested a potential impact of COX-2 targeted therapy in the treatment of renal cell carcinoma with overexpressed COX-2 that needs further investigation.
{"title":"Evaluation of COX-2 expression in renal cell carcinoma and its correlation with clinicopathological factors: a tissue microarray study","authors":"G. Ashour, W. Said","doi":"10.21502/LIMUJ.018.02.2017","DOIUrl":"https://doi.org/10.21502/LIMUJ.018.02.2017","url":null,"abstract":"Objectives: This study, aimed to evaluate the expression of COX-2 in renal cell carcinoma, and correlate it with different patient clinicopathological data, emphasizing on the role of COX-2 as a prognostic factor for renal cell carcinoma and to decide which cases more likely benefit from the targeted therapy later on. Patients and Methods: The present series consisted of tissue samples obtained from 47 patients (30 patients were males and 17 were females). All the tumor samples were collected from the Pathology Department, Faculty of Medicine, Alexandria University during the period from July 2009 to November 2010. Archival paraffin-embedded renal cell carcinoma tissue samples were used to prepare tissue microarray blocks for immunohistochemical staining with COX-2 antibody. Marker expression was categorized for statistical analysis then correlated to clinicopathological variables. Results: The histological types was significantly associated with COX-2 expression, with higher expression being more common in papillary and chromophobe renal cell carcinoma, the majority of these two types were in score 1 and 2 while majority of clear cell renal cell carcinoma had score 0 and 1. Conclusion: The association of COX-2 marker was related to the histologic type of tumor; COX-2 expression study might provide prognostic information regarding tumor aggressiveness. These findings suggested a potential impact of COX-2 targeted therapy in the treatment of renal cell carcinoma with overexpressed COX-2 that needs further investigation.","PeriodicalId":18106,"journal":{"name":"Libyan International Medical University Journal","volume":"158 1","pages":"140 - 151"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87960653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-01DOI: 10.21502/LIMUJ.017.02.2017
Muftah Hamad Elkhafifi, Khalifa Sultan Mohammed, Wael E. Alaorfi, Ameen R. Osman
BACKGROUND: Fournier's gangrene (FG) is a fulminant aggressive necrotizing fascitis affecting the external genitalia, perineum and anterior abdominal wall with significant mortality rate. The aim of the present study was to describe the associated risk factors, presentation, diagnosis, management and outcome of this condition in Benghazi, Libya. PATIENTS& METHODS: Over a period of twenty years (from January 1997 to October 2016) a series of 54 consecutive patients who were admitted to Urology Department, Hawari Center for Urology and Otolaryngology, Benghazi-Libya were evaluated retrospectively to assess the risk factors, etiology, management and outcome of this fatal disease. RESULTS: It was found that 37 (68.5%) of patients were diabetics and 24 patients (44.4%) had perianal abscess as predisposing factor. Mortality rate was 14.8% (8 patients). All cases diagnosed on clinical basis. The patients operated promptly by extensive debridement. Reconstructive surgery done by flap or graft in plastic department to close the skin defect in most of our patients (41 patients, 75.9%). CONCLUSION: The main co-morbidity and predisposing factors of FG are diabetes mellitus and perianal abscess respectively. Prompt aggressive debridement is the only management to save the patient's life.
{"title":"Necrotizing fascitis of male genitalia: A series of fifty-four consecutive patients","authors":"Muftah Hamad Elkhafifi, Khalifa Sultan Mohammed, Wael E. Alaorfi, Ameen R. Osman","doi":"10.21502/LIMUJ.017.02.2017","DOIUrl":"https://doi.org/10.21502/LIMUJ.017.02.2017","url":null,"abstract":"BACKGROUND: Fournier's gangrene (FG) is a fulminant aggressive necrotizing fascitis affecting the external genitalia, perineum and anterior abdominal wall with significant mortality rate. The aim of the present study was to describe the associated risk factors, presentation, diagnosis, management and outcome of this condition in Benghazi, Libya. PATIENTS& METHODS: Over a period of twenty years (from January 1997 to October 2016) a series of 54 consecutive patients who were admitted to Urology Department, Hawari Center for Urology and Otolaryngology, Benghazi-Libya were evaluated retrospectively to assess the risk factors, etiology, management and outcome of this fatal disease. RESULTS: It was found that 37 (68.5%) of patients were diabetics and 24 patients (44.4%) had perianal abscess as predisposing factor. Mortality rate was 14.8% (8 patients). All cases diagnosed on clinical basis. The patients operated promptly by extensive debridement. Reconstructive surgery done by flap or graft in plastic department to close the skin defect in most of our patients (41 patients, 75.9%). CONCLUSION: The main co-morbidity and predisposing factors of FG are diabetes mellitus and perianal abscess respectively. Prompt aggressive debridement is the only management to save the patient's life.","PeriodicalId":18106,"journal":{"name":"Libyan International Medical University Journal","volume":"62 1","pages":"134 - 139"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72859511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-01DOI: 10.21502/LIMUJ.014.02.2017
Faten BenRajab, Hanna Ramadan Gajam, T. Emahbes
BACKGROUND: Hypopituitarism refers to complete or partial failure of pituitary hormones secretion that has a wide range of clinical manifestations which require hormone replacement to eliminate or minimize the symptoms and clinical signs of specific hormone deficiencies. We aimed to identify clinical presentation and management of hypopituitarism in pediatric age group. PATIENTS & METHODS: This is a case series study involving 35 patients who were diagnosed to have hypopituitarism due to different causes at Endocrine Clinic of Tripoli-Children Hospital from 2000 to 2010. Data were collected from patient's hard records in the clinic, which include age at presentation, sex, clinical presentation, associated illness, height, weight, extent of pituitary hormone deficiencies, pituitary imaging findings and hormone replacement status. RESULTS: Out of 35 patients 54.3% were males, 45.7% were females with median age at presentation (10±4.5) years. The most common clinical manifestation was short stature (68.6%) followed by hypoglycemia (14.3%) and delayed puberty (8.6%). 11.4% had Craniopharyngioma. MRI showed normal pituitary in 40% of patients, pituitary hypoplasia in 45.7%. Biochemically, growth hormone (GH) deficiency was evident in 82.9%, low TSH in 17.1%, low T4 in 14.3%, low serum cortisol level in 20%, low ACTH in 11.4%, low FSH in 8.6%, and low LH in 5.7%. The result also showed that 5.3% of males had low testosterone level and 18.8% of females had low estrogen level. Hormonal replacement included GH therapy (85.7%), thyroxine (62.9%), cortisol (45.7%) and sex hormone (31.4%). CONCLUSION: Most common clinical presentation of hypopituitarism was short stature. Symptoms of patients with hypopituitarism improved by appropriate hormonal replacement according to their needs.
{"title":"Presentation and management of hypopituitarism in Tripoli-Children Hospital 2000-2010","authors":"Faten BenRajab, Hanna Ramadan Gajam, T. Emahbes","doi":"10.21502/LIMUJ.014.02.2017","DOIUrl":"https://doi.org/10.21502/LIMUJ.014.02.2017","url":null,"abstract":"BACKGROUND: Hypopituitarism refers to complete or partial failure of pituitary hormones secretion that has a wide range of clinical manifestations which require hormone replacement to eliminate or minimize the symptoms and clinical signs of specific hormone deficiencies. We aimed to identify clinical presentation and management of hypopituitarism in pediatric age group. PATIENTS & METHODS: This is a case series study involving 35 patients who were diagnosed to have hypopituitarism due to different causes at Endocrine Clinic of Tripoli-Children Hospital from 2000 to 2010. Data were collected from patient's hard records in the clinic, which include age at presentation, sex, clinical presentation, associated illness, height, weight, extent of pituitary hormone deficiencies, pituitary imaging findings and hormone replacement status. RESULTS: Out of 35 patients 54.3% were males, 45.7% were females with median age at presentation (10±4.5) years. The most common clinical manifestation was short stature (68.6%) followed by hypoglycemia (14.3%) and delayed puberty (8.6%). 11.4% had Craniopharyngioma. MRI showed normal pituitary in 40% of patients, pituitary hypoplasia in 45.7%. Biochemically, growth hormone (GH) deficiency was evident in 82.9%, low TSH in 17.1%, low T4 in 14.3%, low serum cortisol level in 20%, low ACTH in 11.4%, low FSH in 8.6%, and low LH in 5.7%. The result also showed that 5.3% of males had low testosterone level and 18.8% of females had low estrogen level. Hormonal replacement included GH therapy (85.7%), thyroxine (62.9%), cortisol (45.7%) and sex hormone (31.4%). CONCLUSION: Most common clinical presentation of hypopituitarism was short stature. Symptoms of patients with hypopituitarism improved by appropriate hormonal replacement according to their needs.","PeriodicalId":18106,"journal":{"name":"Libyan International Medical University Journal","volume":"1 1","pages":"112 - 119"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77037004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-01DOI: 10.21502/LIMUJ.016.02.2017
S. Aetrugh, M. Aboshkiwa, Kahled A. Tawil, Usama M. Shweref, M. Erhuma, M. Mustafa
BACKGROUND: The resistance to antimicrobial agents among Staphylococci is an increasing problem. This has led to a renewed interest in the usage of macrolide-lincosamide-streptogramin B (MLSB) antibiotics to treat staphylococcal infections. Clinical failure has been reported due to multiple mechanisms that confer resistance to clindamycin antibiotics. The present study was to investigate the inducible clindamycin resistance among isolates of methicillin resistant Staphylococci by the D-test method. MATERIALS & METHODS: This study was conducted on 218 staphylococcal isolates obtained from different clinical specimens of outpatients and inpatients admitted to Tripoli Central Hospital (TCH), Libya. Methicillin resistance was detected by oxacillin, cefoxitin disc diffusion test (Kirby Bauer method) and confirmed by other biochemical tests. Detection of inducible clindamycin resistance was performed by D-test using erythromycin and clindamycin. RESULTS: Eighty-six out of 218 staphylococcal isolates were resistant to erythromycin,26 (11.9%) isolates were D-test positive indicating inducible (iMLSB) phenotype, 24 (11%) isolates exhibited constitutive (cMLSB) phenotype, while 36 (16.5%) showed true sensitivity to clindamycin indicating (MS) phenotype. The distribution of isolates showing iMLSB phenotype was 12 (19.4%) for methicillin-resistant Staphylococcus aureus (MRSA), 8 (17.0%) for methicillin-resistant coagulase-negative Staphylococci (MRCNS), 6 (6.4%) for methicillin-sensitive Staphylococcus aureus (MSSA) and 0 (0%) for methicillin-sensitive coagulase-negative Staphylococci (MSCNS). CONCLUSION: Higher prevalence of iMLSB phenotype was mainly associated with methicillin-resistant than methicillin-sensitive isolates. We recommend that D-test should be performed to facilitate the appropriate treatment of patients infected with Staphylococci.
背景:葡萄球菌对抗菌药物的耐药性是一个日益严重的问题。这导致了使用大环内酯-利可沙胺-链状gramin B (MLSB)抗生素治疗葡萄球菌感染的新兴趣。临床失败的报道是由于多种机制导致对克林霉素抗生素产生耐药性。本研究采用d检验法对耐甲氧西林葡萄球菌的诱导克林霉素耐药性进行了研究。材料与方法:本研究对从利比亚的黎波里中心医院(TCH)门诊和住院患者的不同临床标本中分离出的218株葡萄球菌进行研究。采用奥西林、头孢西丁圆盘扩散试验(Kirby Bauer法)检测甲氧西林耐药性，并通过其他生化试验证实耐药性。采用红霉素和克林霉素的d试验检测诱导型克林霉素耐药。结果:218株葡萄球菌中有86株对红霉素耐药，26株(11.9%)为诱导型(iMLSB)阳性，24株(11%)为组成型(cMLSB)， 36株(16.5%)对克林霉素(MS)表型敏感。耐甲氧西林金黄色葡萄球菌(MRSA)有12株(19.4%)，耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)有8株(17.0%)，耐甲氧西林金黄色葡萄球菌(MSSA)有6株(6.4%)，耐甲氧西林凝固酶阴性葡萄球菌(MSCNS)有0株(0%)。结论:与甲氧西林敏感株相比，iMLSB表型较高的发生率主要与耐甲氧西林相关。我们建议进行d检验，以便对葡萄球菌感染患者进行适当的治疗。
{"title":"Inducible clindamycin resistance among Staphylococcal clinical isolates from Tripoli Central Hospital, Libya","authors":"S. Aetrugh, M. Aboshkiwa, Kahled A. Tawil, Usama M. Shweref, M. Erhuma, M. Mustafa","doi":"10.21502/LIMUJ.016.02.2017","DOIUrl":"https://doi.org/10.21502/LIMUJ.016.02.2017","url":null,"abstract":"BACKGROUND: The resistance to antimicrobial agents among Staphylococci is an increasing problem. This has led to a renewed interest in the usage of macrolide-lincosamide-streptogramin B (MLSB) antibiotics to treat staphylococcal infections. Clinical failure has been reported due to multiple mechanisms that confer resistance to clindamycin antibiotics. The present study was to investigate the inducible clindamycin resistance among isolates of methicillin resistant Staphylococci by the D-test method. MATERIALS & METHODS: This study was conducted on 218 staphylococcal isolates obtained from different clinical specimens of outpatients and inpatients admitted to Tripoli Central Hospital (TCH), Libya. Methicillin resistance was detected by oxacillin, cefoxitin disc diffusion test (Kirby Bauer method) and confirmed by other biochemical tests. Detection of inducible clindamycin resistance was performed by D-test using erythromycin and clindamycin. RESULTS: Eighty-six out of 218 staphylococcal isolates were resistant to erythromycin,26 (11.9%) isolates were D-test positive indicating inducible (iMLSB) phenotype, 24 (11%) isolates exhibited constitutive (cMLSB) phenotype, while 36 (16.5%) showed true sensitivity to clindamycin indicating (MS) phenotype. The distribution of isolates showing iMLSB phenotype was 12 (19.4%) for methicillin-resistant Staphylococcus aureus (MRSA), 8 (17.0%) for methicillin-resistant coagulase-negative Staphylococci (MRCNS), 6 (6.4%) for methicillin-sensitive Staphylococcus aureus (MSSA) and 0 (0%) for methicillin-sensitive coagulase-negative Staphylococci (MSCNS). CONCLUSION: Higher prevalence of iMLSB phenotype was mainly associated with methicillin-resistant than methicillin-sensitive isolates. We recommend that D-test should be performed to facilitate the appropriate treatment of patients infected with Staphylococci.","PeriodicalId":18106,"journal":{"name":"Libyan International Medical University Journal","volume":"3 1","pages":"128 - 133"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83305807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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