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   Table of Contents - Current issue
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October-December 2021
Volume 5 | Issue 4
Page Nos. 139-178

Online since Monday, February 28, 2022

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ORIGINAL ARTICLES  

Causes of end-stage renal disease among hemodialysis patients in Libya: A multicenter cross-sectional study p. 139
Eman Gusbi, Abrahem F Abrahem, Ahmed Elfituri, Farag Eltaib, Walid M Benbubaker, Inas M Alhudiri, Nada Elgriw, Mokhtar Gusbi, Majda Musa Rmadan, Nabil Enattah, Adam Elzagheid
DOI:10.4103/LJMS.LJMS_75_20  
Background/Aims: Little data are available about chronic kidney disease (CKD) and end-stage renal disease (ESRD) in Libya, therefore, we conducted a cross-sectional study to examine the epidemiological factors and frequency of diseases diagnosed in patients with ESRD who are receiving hemodialysis in the major three demographic areas of Libya. Patients and Methods: With a special focus on the three main demographic regions in Libya (East, West, South), in this study, we retrospectively examine and analyze data retrieved from patients who attended 31 hemodialysis centers in 2017. Patients' data were studied for baseline demographic information, gender, age, medical history, physical examination, laboratory results, and comorbidities. Results: More males than females were affected overall, with M:F ratio = 1.6. Approximately, two-thirds of patients resided in the western part of Libya, with a regional distribution of 68.41% in the West, 16.08% in the East, and 15.52% in the South. The majority of cases with ESRD (>60%) were either caused by hypertension (25.36%) or diabetes mellitus (23.75%), or a combination of both (12.93%). On the other hand, genetic diseases caused 8.18% of the cases, whereas glomerular diseases caused 5.98%. Conclusion: The public health legislators and Ministry of Health should focus on tackling the modifiable risk factors of hypertension and diabetes early at a population level to reduce the burden of CKD and the development of ESRD. Early detection of genetic causes is an important health measure through the implementation of screening in high-risk groups and appropriate genetic counseling.
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Frequency of breast disease among patients attending breast clinic in tripoli central hospital, Tripoli, Libya p. 144
Fatma Alsharif, Sarah Abdulrazik, Inas Alhudiri, Adem Elzagheid, Faisal Ismail
DOI:10.4103/ljms.ljms_12_21  
Background and Aims: Breast cancer is the most common cancer in women in the world. This study is aiming to assess the frequency of breast cancer and other breast diseases in Libyan women attending breast clinic in Tripoli Central Hospital. Materials and Methods: A cross-sectional survey was obtained through interview questionnaires after having obtained ethical approval. Four hundred patients seeking medical consultation in the outpatients' breast clinic of Tripoli Central Hospital, Libya, from August to October 2019 were included in this study. Results: Women aged 35–50 years were the most visiting age group to the breast clinic (53.3%), followed by women older than 50 years and the age group of < 35 years old was the least with about (26%). According to this study, the most common presentation was breast mass (71.8%), the second was breast pain then a nipple discharge with only 8.3%. Patients diagnosed with breast cancer represent 27.5% of patients who attended the clinic, and the majority was having benign conditions. Conclusion: The majority of breast lumps are benign and cancer cases represent <1/3rd of cases attending the breast clinic at Tripoli Central Hospital, Tripoli, Libya. Public health education and awareness campaigns regarding the early detection of breast cancer are needed to reduce cancer mortality.
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Prevalence of meropenem and imipenem resistance in gram-negative uropathogens in ibn sina clinic in Benghazi-Libya p. 148
Huda Mohammed Gargoum, M Muftah Muftah, M Alsieah Zinab, Elsharee Khadija
DOI:10.4103/ljms.ljms_55_21  
Background/Aims: The carbapenem resistance is increasing worldwide. Although there are a number of studies on carbapenem resistance available in western Libya, there is no adequate information in eastern Libya. The aim of the present work was to study the prevalence of both imipenem and meropenem in uropathogens in one hospital in Benghazi, a city in Libya, to know the magnitude of resistance caused by these groups of bacteria. Subjects and Methods: A total of 1011 samples of patients with urinary tract infection were collected from August 1, 2019, to April 30, 2020. Identification of the isolates was done and the antibiotic susceptibility of different uropathogens was tested for their imipenem and meropenem susceptibility. Results: The prevalence of Escherichia coli was 68.8%, followed by Klebsiella pneumonia and Proteus mirabilis (12.4% and 4.8%, respectively). The prevalence of Pseudomonas aeruginosa was also (12.4%), and the Acinetobacter baumannii comes next by 1.6%. Conclusions: Compared to different results done in different parts of Libya, the prevalence of carbapenem was increased and this expanded to other Enterobacteriaceae as P. mirabilis that has not declared in previous data in different regions in Libya.
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Nurses' perception of medication administration errors in benghazi children hospital p. 153
Ainas Salem Eltarhuni, Hajir Omar Tawfeeq, Jebril S El-Abidi
DOI:10.4103/ljms.ljms_49_21  
Background/Aims: Medication Administration Errors (MAEs) are a global problem, common among nurses and can threaten all patients' outcomes. Variation of factors makes pediatrics more vulnerable to medication errors (MEs) and its consequences. Therefore, his study aimed to explore the perspective of pediatric nurses regarding the types, causes of errors, and barriers of reporting errors. Methods: A descriptive, cross-sectional study carried out between January and May 2021. A self-administered was the instrument for the study, distributed to 150 nurses working in Benghazi Children Hospital and 102 questionnaires were valid and complete. Data analyses were performed by descriptive statistics, using SPSS. Results: Administering medication at a wrong time was the most common type of error, followed by wrong rate (62.8% and 47.1%), respectively. The most frequently identified causative factors of MEs were a shortage of nurse staffing compared to the number of patients 76.4% and workload 73.5%. The majority of nurses did not report any MEs, the reasons for not reporting was 46.1% of nurses fear of concentration of personal more than error and 34.3% of them not sure when should report the MEs. Conclusion: MEs are a common problem in the health system. Therefore, this study recommended that strategies to eliminate MEs are required, create blame-free environment for reporting, and encouraging an effective communication.
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Malaria in illegal immigrants in Southern Libya p. 158
Fadwa J Mahanay, Abdulla M Bashein, Abdulnasser A EI-Buni, Almabrouk Sheebah, Badereddin B Annajar
DOI:10.4103/ljms.ljms_58_21  
Background and Aims: The risk of malaria re-introduction to Libya is increasing due to immigration to Libya from sub-Saharan countries where malaria is endemic. This study was conducted to investigate the prevalence of malaria-positive cases among illegal immigrants in the southern region of Libya. Materials and Methods: Three hundred and three illegal immigrants, with a mean age of 25.78 ± 5.92 years, from 12 different countries were included. An enzyme-linked immunosorbent assay was used to detect the presence of serum malaria antibodies. Results: One hundred and ninety-five (64.36%) of the participants tested positive for malaria antibodies. One hundred and seventy-two of the positive cases arrived in Libya within 1–10 months. The highest number of positive cases (70) came from Ghana, followed by (40) from Niger and (39) from Bangladesh. Conclusion: Illegal immigration issue should be treated urgently, combined by increasing the surveillance activities of infectious diseases to prevent malaria re-introduction to Libya.
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SHORT COMMUNICATION Top

Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus-2 Antibodies among People Living with HIV: A Cross-sectional Study from Tripoli University Hospital p. 162
Nader S Shalaka
DOI:10.4103/ljms.ljms_1_22  
Background/Aims: Patients with preexisting morbidities (e.g., malignancy, posttransplant, and heart failure) are recognized to be at increased risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, as well as increased risk of mortality after infection. However, there are conflicting data on the susceptibility and prevalence of infection among people living with HIV (PLWH), with higher, lower, and equal prevalence to the general population were reported. The aim of this study was to assess the prevalence of SARS-CoV-2 antibodies among PLWH who are attending clinical care at the Department of Infectious Diseases of Tripoli University Hospital. Materials and Methods: A cross-sectional study conducted during the period from October 01, 2021 to December 01, 2021 at the (Department of Infectious Diseases) outpatient clinic of Tripoli University Hospital. The OnSite Coronavirus Disease 2019 IgG/IgM Rapid Test (CTK Biotech, San Diego County, California, USA) was used to determine the presence of antibodies against the spike protein of SARS-CoV-2 in the collected serum samples. The test results were reported as “Negative” or “Positive” as per the manufacturer's instructions. Results: A total of 108 PLWH were included in the study. Sixty-nine (64%) were male, and the mean age for participants was 44 years. Specific IgG/IgM antibodies for SARS-CoV-2 were detected in 31 individuals, representing a seroprevalence of 28.7%. Conclusions: High seroprevalence of SARS-CoV-2 antibodies among nonvaccinated PLWH attending clinical care at Tripoli University Hospital. They require pritorization on vaccination and boosting.
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CASE REPORTS Top

COVID-19 mRNA vaccination-induced lymphadenopathy mimics lung cancer metastasis on fluorodeoxyglucose PET/CT scan p. 165
Yukihiro Hama, Etsuko Tate
DOI:10.4103/2588-9044.338635  
A 66-year-old man with stage IIA nonsmall cell lung cancer who had complete response to radiation therapy 4.5 years earlier underwent a fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan due to elevated CA19-9 levels. PET/CT scan showed a new cluster of left axillary and supraclavicular lymphadenopathy with increased FDG uptake suggesting lymph node metastasis. Later, it was found that the patient received the second dose of coronavirus disease 2019 mRNA vaccine 7 days before the PET/CT. Retrospective evaluation showed a vague linear-shaped metabolic activity in the left deltoid muscle with mild FDG uptake in the injection site. Based on the detailed history and PET/CT findings, a diagnosis of vaccination-induced lymphadenopathy was made. This diagnosis was confirmed after 6 months of follow-up.
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Failure of therapeutic enoxaparin to prevent massive deep vein thrombosis and cerebral venous sinus thrombosis in a pregnant patient with combined factor v leiden mutation and antithrombin iii deficiency p. 168
Husam Nabil Abduljabbar Al-Dubai, Yousef Mohammed Hailan, Abdulrahman Al-Mashdali, Akram Fadhl Mohammed Al-Warqi, Bisher Sawaf
DOI:10.4103/ljms.ljms_59_21  
Women with combined inherited thrombophilia are at high risk of developing thrombotic events, especially when they are pregnant. Low-molecular-weight (LMW) heparins are the preferable agents for anticoagulation during pregnancy. Despite the fact that they have been proven to be effective in the treatment and prevention of venous thromboembolism, thrombotic events can still happen. Here, we report a case of a 40-year-old white pregnant woman with combined factor V Leiden mutation and antithrombin III deficiency who developed massive deep vein thrombosis and cerebral venous sinus thrombosis despite being on therapeutic doses of enoxaparin.
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Primary invasive gastric mucormycosis presenting as meleney's gangrene: A case report and review of literature p. 171
Mohamad Safwan, Shafy Ali Khan, Anni Belthazar, Madhu Sasidharan
DOI:10.4103/ljms.ljms_45_21  
Mucormycosis is an uncommon but potentially lethal fungal infection in immunocompromised individuals. The natural history of the disease is vascular invasion followed by thrombosis and necrosis of infected tissues. It can affect any organ system. Gastrointestinal (GI) mucormycosis is quite rare. Here, we report a case of primary invasive gastric mucormycosis in a 45-year-old male with diabetes and ethanol-related chronic liver disease who presented with necrotizing fascitis of the left thigh, groin, and lower abdominal wall. At presentation, he was hemodynamically unstable, anuric, and febrile with a high blood glucose level. He was stabilized with aggressive debridement and critical care management. During hospitalization, he developed sudden episode of upper GI bleed. Gastroscopy revealed extensive ulcerations with thick mucus in the fundus and body of the stomach. Biopsy from the lesions and special stain examination was consistent with invasive gastric mucormycosis. Delayed presentation of our patient and rapid progression to fungemia resulted in mortality.
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Pure interventricular craniopharyngioma: A case report and literature review p. 174
Issa Ali Muftah Lahirish, MB Sales, Cassia Prado, Jose Marcus Rotta, Mateus Reghin Neto
DOI:10.4103/ljms.ljms_54_21  
Craniopharyngiomas (CPs) of the third ventricle are rare and can be difficult to treat due to their deep location and relation to neurological structures. A 60-year-old woman presented with a history of memory disturbances with progressive course. On examination, she was conscious but disoriented with time and place, visual field showed bilateral superolateral quadrantanopia, and KPS was 90. Brain images revealed a third ventricular mass that bowed the floor of the third ventricle, expanding into the supraoptic recess, compressing the optic chiasm downward and forward. The mass had solid and cystic components at its inferior and periphery. The patient underwent right pretemporal approach with orbital roof being removed, and a translamina terminalis route was used to reach the third ventricle and the tumor was completely removed. Preoperative localization of the ventricular CPs is essential to choose the optimal surgical approach to avoid undesired injuries and improve the surgical outcome.
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LETTER TO EDITOR Top

Posterior reversible encephalopathy syndrome secondary to blood transfusion p. 177
Jamir Pitton Rissardo, Ana Leticia Fornari Caprara
DOI:10.4103/ljms.ljms_62_21  
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