Libyan Journal of Medicine最新文献

A concerning trend has recently emerged in Libya where cancer patients are seeking unproven herbal remedies derived from local Artemisia species driven by circulating claims on social media. These unregulated traditional medicines can interact with standard cancer treatments such as chemotherapy and radiation therapy. Scientific evidence suggests that Artemisia compounds can alter drug metabolism through enzymatic pathways (notably the CYP450 system), potentially neutralizing treatment efficacy or exacerbating systemic toxicity. This letter evaluates the toxicological profile of Artemisia and proposes an ethical framework for patient protection and public health intervention in Libya.

Hemoptysis, often life-threatening in its massive form, is predominantly caused by bronchial artery pathology. Bronchial artery embolization (BAE) is the established first-line intervention, yet the relationship between bronchial artery morphology and embolization outcomes remains insufficiently defined. This prospective pilot study aimed to assess the association between bronchial artery anatomical features and short-term outcomes following BAE, and to evaluate concordance between computed tomography (CT) angiography and digital subtraction angiography (DSA) in detecting hypertrophy and tortuosity. Twenty-eight patients with hemoptysis requiring BAE were prospectively enrolled in a cohort study. Baseline multidetector CT angiography characterized bronchial artery origin, diameter, hypertrophy, tortuosity, and systemic collaterals. All patients underwent DSA-guided BAE. Treatment success was defined as cessation of hemoptysis within 48 hours, with recurrence assessed at 30 days. Inter-modality agreement was measured using Cohen's kappa. Immediate success was achieved in 92.9% of cases, with recurrence observed in 14.3% at 30 days. No statistically significant associations were found between artery morphology and outcomes. Descriptive trends suggested higher recurrence in patients with systemic collaterals and smaller left bronchial artery diameters (<2 mm). Moderate agreement was observed between CT and DSA for hypertrophy detection (Kappa = 0.563 for right bronchial artery, 0.500 for left), while substantial agreement was found for tortuosity (Kappa = 0.710 and 0.774, respectively). CT angiography demonstrated moderate concordance with DSA for hypertrophy detection (Kappa = 0.563 for right bronchial artery, 0.500 for left), while substantial agreement was found for tortuosity (Kappa = 0.710 and 0.774, respectively). Bronchial artery morphology was not significantly predictive of short-term BAE outcomes, though systemic collaterals and small vessel diameters may contribute to recurrence risk. While moderate agreement limits CTA as a sole tool, it aids in identifying targets efficiently. Larger, multicenter studies are warranted to refine risk stratification and optimize hemoptysis management.

Research performance in the Middle East and North Africa (MENA) is often assessed using national aggregates that mask substantial institutional variation. Evidence on how output, quality, and excellence relate to economic resources and institutional capacity across the region remains limited. Data from the SCImago Research Centers Rankings were used to analyze 321 non-university, non-health research centers across 22 MENA countries. Indicators included research output, Quality, Excellence, collaboration, innovation, and Institutional Citation Impact per researcher (ICI/T). Analyses were conducted at both country and institutional levels using descriptive statistics, correlation analysis, and clustering. The analysis reveals extreme heterogeneity within and across countries. National income is strongly associated with research Excellence but shows a much weaker relationship with baseline Quality. ICI/T is strongly associated with Excellence and displays reduced variance at higher values, indicating increasing stability of elite performance. Clustering identifies multiple tiers of research systems that cut across income categories. A small group of countries exhibits disproportionately high Excellence relative to weak institutional impact, consistent with structural decoupling. International collaboration supports Quality but does not predict Excellence, while regional and industry collaboration remain limited. Economic resources accelerate elite research performance but do not guarantee high baseline quality. Long-term research performance in the MENA region depends primarily on institutional alignment, governance, and sustained capacity building rather than output expansion alone.

Pyrazole derivatives are a class of heterocyclic compounds known to have broad pharmacological effects. This study aimed to synthesize and characterize a new series of pyrazole derivatives and investigate their effects on a series of in vitro assays. Five synthesized compounds were confirmed structurally using standard spectroscopic techniques, and their cytotoxic activity was evaluated against HeLa cells using MTT assay and morphological examination of viability. DNA damage and fragmentation were analyzed using a comet assay, agarose gel electrophoresis, and diphenylamine reaction. Antioxidant properties were evaluated with radical scavenging assays, and anti-inflammatory potential was assessed with in vitro inhibition assays (COX-1/2). Pyrazolethione 5 showed antiproliferative effects at all concentrations, with preserved cell confluence at ≤62.5 µg/mL. It also demonstrates DPPH scavenging activity similar to that of ascorbic acid in a dose-dependent manner, reaching a maximum activity of 85.9% with an IC₅₀ of 48.77. In addition, it demonstrated antioxidant activity, although significantly lower than that of gallic acid, with a maximum scavenging percentage of 83.9% at 1000 μg/mL and an IC₅₀ of 54.97 μg/mL. In the comet assay, the treatment significantly increased DNA fragmentation to 26.2% ± 0.88% from 12.8% ± 0.77% in the control cells (p < 0.01), representing a two-fold induction of apoptosis. The test compound inhibited COX-1 in a dose-dependent manner (86.29% inhibition at 1000 µg/mL), producing an IC₅₀ value of 29.14 ± 0.97 µg/mL, while it produced moderate inhibition of COX-2, 82.03% inhibition at 1000 µg/mL, and had an IC₅₀ value of 51.49 ± 2.13 µg/mL. According to flow cytometry analysis, untreated HeLa cells were mainly in G1 (54.56%) and G0 (34.86%), with fewer cells in S (9.63%), and G2-M (0.94%). In pyrazolethione-treated HeLa cells, G0 accumulation (73.57%) and fewer proliferative phases (S 3.10% and G2-M 2.78%) indicated substantial alteration to the cell cycle. Pyrazolethione 5 demonstrates a favorable safety profile, with minimal cytotoxicity at lower concentrations, and impressive antioxidant and anti-inflammatory activities. The DPPH and gallic acid-like radical scavenging activities, moderate COX-1 and COX-2 inhibition, and DNA fragmentation suggest multiple bioactivities. Furthermore, the compound significantly altered cell cycle progression in HeLa cells, leading to G0/G1 arrest and reduced proliferation. Taken together, the data indicate pyrazolethione 5 is a potential lead compound for further development/investigation as an anticancer and anti-inflammatory agent with low toxicity.

Hyponatremia has been found to be associated with chronic obstructive pulmonary disease (COPD) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, there is a lack of systematic evidence on the prevalence and impact of hyponatremia in COPD and AECOPD patients. We performed a systematic search on three major databases for articles published on or before 31 July 2025. We included all the studies reporting the prevalence or number of hyponatremia cases in COPD patients (stable and exacerbation) aged 18 years and above. Pooled prevalence was calculated by a random effects model using RStudio. The Joanna Briggs Institute (JBI) tool was used for quality evaluation of the included studies. In this systematic review and meta-analysis, we included 11 studies out of 284 studies retrieved in the initial search. Of these 11 studies, three were COPD studies, and eight were AECOPD studies. The pooled prevalence of hyponatremia among COPD patients was 14% (95% CI: 4%-28%), with significant heterogeneity (I² = 98.3%, p < 0.0001). The pooled prevalence of hyponatremia in AECOPD patients was 19% (95% CI: 9%-32%), with significant heterogeneity (I² = 98.8%, p < 0.0001). Most of the studies showed that hyponatremia was not associated with mortality as an outcome of AECOPD. This study found a high prevalence of hyponatremia in both COPD and AECOPD patients; however, substantial heterogeneity (I² > 98%) necessitates cautious interpretation of pooled estimates. Future studies with standardized diagnostic criteria and larger sample sizes are needed to establish more precise prevalence rates.

EMMPRIN is a widely distributed cell surface glycoprotein that belongs to the immunoglobulin (Ig) superfamily. It induces the production of extracellular matrix metalloproteinases (MMPs) and plays an important role in angiogenesis via stimulation of vascular endothelial growth factor (VEGF). The aim of the present work was to assess and compare the expression of extracellular matrix metalloproteinase inducer (EMMPRIN) in different oral nonodontogenic carcinomas. Fifty-four diagnosed cases of oral nonodontogenic carcinomas were selected, and biopsies were taken from the tumor tissue, fixed, processed, and cut into sections to be stained with hematoxylin and eosin (H&E) for routine histopathological examination. Immunohistochemistry was performed for EMMPRIN. All cases showed positive EMMPRIN expression with different intensities. The results were recorded and statistically analyzed using student t-test, Pearson correlation, test and ANOVA test. This study concluded that elevated EMMPRIN expression is correlated with tumor proliferation, angiogenesis, metastasis, and invasion.

Assessment of risk factors of breast cancer in the general population provides insightful information towards prevention of breast cancer. This study aimed to assess the risk factors of breast cancer among women in a community from a resource-limited setting in sub-Saharan Africa. This descriptive community-based cross-sectional study was conducted in Dodoma, Tanzania, from July to December 2020. The study included women aged between 18 and 70 years. The data were analyzed using SPSS program version 25.0. Independent t-test was used to compare the mean age of the participants for the availability of risk factors of breast cancer. A two-tailed p < 0.05 was considered significant. A total of 354 women were analyzed, and the median age was 27.0 (23.0-35.3) years. Only 11.8% (n = 18) of all the participants did not have any of the risk factors examined. Not engaging in physical activity was the most frequent risk factor which accounted for 68.2% (n = 242) of all the participants. There were more 60.7% (n = 215) of the study participants with a low mean age (22.9 ± 3.5) who had more than 5 risk factors compared to 39.3% (n = 139) of the participants with a high mean age (25.3 ± 9.4) who had more than 5 risk factors, with no statistically significant difference (95% CI = 0.91-2.22, p = 0.31). There is a large proportion of women younger than 40 years in the population of Tanzanian women with many risk factors of breast cancer. This may contribute to the currently observed increase in the incidence of breast cancer in Tanzania for women aged less than 40 years. Therefore, there is an urgency for targeted awareness and screening for breast cancer among younger women in Tanzania so as to increase early detection and diagnosis.

Effective diabetes care must address not just the clinical metrics but also this psychological interplay, empowering patients to drive the proactive engagement needed for long-term health. This study aims to explore the mediating effect of the patient activation role on diabetes self-care adherence and diabetes distress. A cross-sectional study was conducted with a convenience sample of 428 adults with type 2 diabetes recruited from diabetes clinics. Participants completed validated surveys through the Patient Activation Measure, Diabetes Distress Scale, and Summary of Diabetes Self-Care Activities. The data were analyzed using correlation and structural equation modeling to test the proposed mediation model. Significant negative correlations were found between patient activation and diabetes distress (r = 0.310, p< 0.001), and positive correlations were found between patient activation and self-care adherence (r = 0.588, p < 0.001). As hypothesized, patient activation significantly mediated the relationship between higher self-care adherence and lower diabetes distress, accounting for 45% of the total effect (indirect effect: β = -0.268). These findings demonstrate that patient activation is a key mechanism through which self-care adherence reduces diabetes distress. This suggests that interventions specifically designed to enhance patient activation can break the cycle of distress by empowering individuals to engage more effectively in self-care behaviors, ultimately improving both psychological and clinical outcomes in diabetes management. Integrating routine assessments of patient activation and distress into clinical practice is recommended.

Preoperative anxiety is a feeling of insecurity, physical and psychological discomfort that arises from the prospect of undergoing surgery. Managing anxiety is a therapeutic cornerstone in anesthetic care. Virtual reality has shown a significant effect on managing anxiety and pain by leveraging the principle of distraction, hypnosis, or a combination of distraction and relaxation. We aim to study the impact of virtual reality on perioperative anxiety during surgeries performed under regional anesthesia. This was a monocentric, prospective, randomized study conducted over a three-month period from March 2023 to May 2023 in the anesthesia and resuscitation department of Taher Sfar Hospital in Mahdia. A total of 72 patients scheduled for orthopedic surgeries were included. Patients were randomized to be allocated to: VR+ group (n = 36), who experienced virtual reality during the operation, or the VR- group (n = 36), who did not experience virtual reality. The consumption of anxiolytics (Midazolam) was evaluated intraoperatively along with perioperative anxiety levels (ICD-11 code MB24.6). Anxiety levels were assessed using the STAI-6, and LIKERT scales. Patient satisfaction was measured using the LIKERT scale. Data from 68 patients were analyzed, with 34 patients in each group. Our study showed that there were no significant differences in preoperative anxiety levels between the groups (average STAI-6 score: VR- = 43.2 vs. VR+ = 44.8). Virtual reality reduced the frequency of anxiolytic use intraoperatively: 61.7% in the VR- group vs. 5.8% in the VR+ group (p < 0.001), as well as the quantity used. Postoperative anxiety reduction was comparable between groups. All patients included in the study exhibited very low anxiety levels according to the STAI-6 score, taking preoperative anxiety levels into account. Virtual reality can be considered an effective method for managing perioperative anxiety during surgeries under regional anesthesia and helps prevent postoperative complications.

Cryopreservation of sperm is routinely used in assisted reproduction technology (ART) for male fertility preservation. However, this method has been associated with oxidative stress and DNA fragmentation that may impair sperm quality. Additionally, antioxidant interventions such as melatonin supplementation have not been thoroughly explored in this setting. Although Libya is reported to have one of the highest global prevalence rates of male infertility, Libya-specific data remain limited. This study aimed to determine the effect of a single freeze-thaw cycle on sperm DNA fragmentation and oxidative stress markers, and to evaluate whether melatonin has an impact on post-thaw oxidation profiles. This prospective cohort study was conducted at the Fertility and Reproductive Medicine Center, Beirut Hospital, Benghazi. Semen samples of 104 normozoospermic Libyans were evaluated before and after freezing. DNA fragmentation index (DFI) was measured by sperm chromatin dispersion (SCD) test, and reactive oxygen species (ROS) were quantified by using luminol-enhanced chemiluminescence. In a subset of ejaculates, aliquots were supplemented with 2 mM of melatonin prior to cryopreservation. Cryopreservation was associated with a statistically significant increase in DFI (46.3 ± 18.3% to 60.0 ± 23.0%; p < 0.001) and ROS levels (3.2 × 10³ to 14.7 × 10³ RLU/s; p < 0.001). Smokers presented significantly higher DFI at both pre-freeze and post-thaw evaluations (p < 0.001). We detected a positive correlation between ROS and post-thaw DFI (r = 0.68; p < 0.001). Melatonin-treated samples exhibited moderate but significant differences in ROS (12%, p = 0.045) and DFI (11%, p = 0.004) compared to untreated aliquots. These findings suggested that the freeze-thaw process may contribute to oxidative and genomic stress in spermatozoa, while melatonin supplementation appears to provide limited protection. Larger, multicenter studies incorporating ART endpoints are required to determine the potential translational relevance of these findings.