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.

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.

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.

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.

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.