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.

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.

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.

The Global Lung Function Initiative (GLI) has developed race-neutral reference equations to represent global diversity better and improve fairness across populations. However, the applicability of these equations across different populations, including Middle Eastern populations, remains to be explored. This study aimed to evaluate the suitability of the GLI-2022 equations among healthy Iraqi adults. A cross-sectional study was conducted on 3,828 healthy non-smoking adults (49.8% females) who were 18 years and older. Spirometric measurements, including forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and FEV₁/FVC were obtained, and z-scores were calculated using the GLI-2022 equations. Mean z-scores, age and height were assessed using linear regression and quantile analyses. Mean z-scores for all spirometric measurements were above zero in both sexes. Among females, mean z-scores for FEV₁, FVC and FEV₁/FVC were 1.18 (SD 1.41), 0.81 (SD 1.29) and 0.666 (SD 0.92) respectively. In males, the corresponding values were 0.96 (SD 1.41), 0.61 (SD 1.30) and 0.643 (SD 1.02), with p < 0.001 suggesting that the GLI-2022 equations systematically underestimated lung function. None of the mean z-scores fell within the physiologically acceptable range (±0.5), indicating a poor fit. Additionally, z-scores varied significantly with age and height. Taller and older individuals showed lower FEV₁ and FVC z-scores, indicating an overestimation of lung function. This variability was more pronounced in males. The GLI-2022 equations systematically underestimated FEV₁ and FVC of the Iraqi population, with mean z-scores exceeding the acceptable ±0.5 range. Age- and height-dependent deviations further indicate that GLI-2022 does not adequately represent this population, underscoring the need for regional validation before adopting these equations to ensure accurate diagnosis and appropriate clinical management.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a growing public health concern because of its increasing prevalence and harmful effects on physical and mental health. This disorder leads to disruptive symptoms such as daytime sleepiness and fatigue, which negatively affect vigilance, productivity, and quality of life. To investigate the impact of OSAHS severity on quality of life, productivity, and anxiety disorders in an active population. This cross-sectional study was conducted from January 2018 to June 2023 at Sahloul University Hospital among patients diagnosed with OSAHS. Excessive daytime sleepiness was assessed via the Epworth Sleepiness Scale, quality of life via the SF-12 Health Survey, mental health via the Hospital Anxiety and Depression Scale (HAD), and work productivity via the Work Productivity and Activity Impairment (WPAI) questionnaire. During the study period, 93 active patients diagnosed with OSAHS were included. Severe OSAHS was identified in 35 patients (37.6%). Male sex and tobacco smoking were associated with increased severity of OSAHS (p = 0.002 and 0.005, respectively). Patients with severe OSAHS had a higher body mass index (BMI) (p = 0.043). A significant association was observed between depression and anxiety scores and the severity of OSAHS (p = 0.018 and 0.025, respectively). An alteration in quality of life was more pronounced in patients with severe OSAHS (p < 0.001). In terms of productivity, the severity of OSAHS was correlated with alterations in the four dimensions of the WPAI. After binary logistic regression, the severity of OSAHS was associated with BMI (p = 0.005; aOR = 1.16; 95% CI [1.04-1.29]) and presenteeism (p < 0.001, aOR = 1.08; 95% CI [1.04-1.11]). OSAHS has substantial professional repercussions and negative impacts on patients' quality of life. As this is a cross-sectional study, only statistical associations can be inferred. Nonetheless, promoting screening and access to care is crucial at both the individual and organizational levels.

Metabolically dysfunction-associated steatotic liver disease (MASLD) has emerged as the leading chronic liver disease worldwide, driven primarily by metabolic derangement. The current investigation proposes to elucidate the hepatoprotective mechanisms of telmisartan (TEL) in MASLD. Twenty-four male Wistar rats were allocated to four groups (Control, MASLD, TEL-treated, and MASLD/TEL). Lipid profiles, glycemic markers, liver enzymes, and hepatic markers of oxidative stress (malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), and catalase) were measured. MASLD-associated genes retrieved from GeneCards® were mapped to Rattus norvegicus ortholog genes using the gprofiler2 R package. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Reactome enrichment analyses were subsequently performed using the clusterProfiler R package. Hepatic inflammatory cytokines (TNF-β, IL-6, and NF-κB), mitochondrial respiratory enzymes (Complexes I-IV), and the gene expression of Nrf2, HO-1, MMP-9, and TIMP-1 were evaluated using spectrophotometric assays for mitochondrial respiratory enzymes. Histological assessment was done using Hematoxylin and Eosin (H&E) staining, Masson's trichrome, and TGF-β immunostaining. TEL ameliorates MASLD-associated disturbances in the serum ALT level and lipid profile. It significantly reduces the levels of oxidative stress markers. KEGG and Reactome enrichment highlighted pathways involved in lipid metabolism, insulin resistance, and inflammation, with the peroxisome proliferator-activated receptor (PPAR) and AMP-activated protein kinase (AMPK) signaling pathways being the most enriched. TEL treatment increased the hepatic expression of Nrf2, HO-1, and TIMP-1 while decreasing the expression of MMP-9. The levels of the proinflammatory cytokines TNF-α and IL-6 decreased. The activities of mitochondrial enzymes (citrate synthase and complex I) improved. MASLD induced marked hepatic fibrosis, which was markedly improved following TEL treatment. TEL has notable hepatoprotective properties in MASLD by enhancing metabolic parameters, decreasing oxidative stress, and moderating inflammatory reactions.

Despite the wide availability of contraception, the abortion rate in Serbia remains high. Being in a steady relationship and perceiving low risk to catch sexually transmitted infections have been identified as the most common reason to not use condom, while around 11% of females used oral contraceptive pill. The study aim was to investigate the reasons of Serbian women to seek induced abortion as well as the factors that might impact the decision to terminate pregnancy. A cross-sectional study was conducted at the Clinic for Ob/Gyn, University Clinical Centre of Serbia in Belgrade, which is a referral public tertiary health care institution. Women who underwent induced abortions from 2022 to 2024 filled in a questionnaire on socio-demographic characteristics, life-style and habits, medical history and motives for an induced abortion. Multivariate regression models were used to identify factors associated with each reported abortion motive. The study analyzed 433 women aged 16 to 49 years (mean 32.0 years). The most common motives for abortion were already having enough children (44.3%) and financial difficulties for child upbringing (42.0%). In contrast, gaining weight and concerns about physical changes due to pregnancy was the least endorsed reason for seeking an abortion. The majority of women (52.9%) reported multiple motives for abortion. Motives were generally the same for women who the first and recurrent abortion. Most common factors influencing the decision to terminate pregnancy were not being in a relationship or marriage and vigorous physical activity at workplace. One-half of women had multiple motives for abortion and more than 50% of women sought abortion multiple times. The most important factors associated with voluntary abortion seeking is not having a steady partner and working in a physically demanding job. These findings should be considered in the public health policy agenda.

Formal training for residents-as-teachers is increasingly emphasized in many institutions worldwide. This study investigated 'residents-as-teachers' training, perceptions, and practices at the Faculty of Medicine of Sousse. An online survey was sent to the residents of FMSo (n = 1060). The three assessed areas in the survey were: training and teaching experience, teaching practices used, and attitudes and perceptions. Statistical analyses included descriptive statistics, two-proportion tests, and multivariate logistic regression. One hundred five residents responded (response rate: 9.9%). Although 68.6% reported teaching weekly (often 1-5 hours), and 33.3% found it enjoyable or rewarding, a notable feedback gap existed: 17.1% received no feedback from supervisors, and 15.2% none from learners. Preferred teaching methods included clinical case discussions (40.9%), role-playing (38.0%), brainstorming (37.1%), and workshops (35.2%). Multivariate analysis showed residency year was the only predictor of teaching contribution (OR = 3.72; p< 0.001). Despite limitations like the low response rate, the study concludes that residents value teaching but lack adequate feedback. It underscores the critical need to develop new and refine existing training programs for residents-as-teachers to improve the overall quality of medical education.

The utility of carotid artery Doppler flow velocity (CADFV) over mortality is not well known. This study investigated the utility of bedside ultrasound in assessing volume status and predicting mortality in patients with septic shock with CADFV, the inferior vena cava collapse index, and the central venous pressure (CVP). This prospective observational study included adults admitted to the ED with septic shock, defined by hypotension (SBP < 90 mmHg or MAP < 65 mmHg) and evidence of end-organ hypoperfusion. Patient demographics, CVP, CADFV, inferior vena cava (IVC) diameter, inferior vena cava collapsibility index (IVCCI), and outcomes were recorded. Measurements are compared in terms of mortality. The mean age was 67 years, with a 57% mortality rate. ROC analysis revealed that CADFV predicted mortality with a sensitivity of 72% and a specificity of 68% at a cutoff of 50 cm/s. The IVCCI had 93% sensitivity and 85% specificity at a cutoff of 54.5%. The CVP had 61% sensitivity and 71% specificity at a cutoff of 1.5 mm H₂O. The mean IVCCI was 59%, and the mean CVP was 2.4 mmH₂O. The mean IVCCI was 59%, and the mean CVP was 2.4 mmH₂O. The deceased patients had a mean IVCCI of 63% and a mean CVP of 1.62 mmH₂O, whereas discharged patients had a mean IVCCI of 55% and a mean CVP of 3.45 mmH₂O. CADFV, IVCCI, and CVP can be used in evaluating the volume status and predicting mortality in septic shock. These noninvasive measures provide alternatives to invasive methods and facilitate timely intervention in emergency care.