Background and Aims: Inappropriate uses of antibiotics for the treatment of common self-limiting infections are a major dispensing malpractice worldwide. This potentially may result in the development of resistant bacterial strains, which represents a significant public health problem. This study aimed to describe the pattern of antibiotics dispensing between community pharmacists (CPs) and general practitioners (GPs) regarding symptomatic diagnosis, antibiotic categories, and adherence to therapeutic doses. Subjects and Methods: Between March and June 2017, using trained simulated patients (SPs) with simulated clinical scenarios of having upper respiratory tract infections, a cross-sectional observational study of antibiotic dispensing encounters was conducted at 20 randomly selected pharmacies and clinics in the city of Tripoli, Libya. SPs were trained to deal with both expertise and record their notice after each visit in specific form developed by the researcher. The data were descriptively analyzed using Chi-square and Fisher's exact tests at alpha level of 0.05. Results: CPs dispensed more antibiotics than GPs (P = 0.001) for treating symptoms of common cold. They dispensed more amoxicillin (n = 32, 53.5%) than GPs (n = 18, 30.0%) (P = 0.001). While no CP dispensed ciprofloxacin, only two GPs dispensed this category (P = 0.022). In general, GPs comply better with the symptomatic diagnosis standard than CPs. On the other hand, CPs (n = 26, 59%) adhered better than GPs (n = 4, 12.5%) to therapeutic doses (P = 0.001). Conclusions: The findings suggested poor professional practices by both CPs and GPs. Antibiotic dispensing regulation policies need to be implemented in Libya and CPs must practice ethically.

Background and Objective: Cerebral venous sinus thrombosis (CVST) is associated with serious morbidity and mortality. This study aimed to analyze the characteristics of patients with CVST, clinical features, and predisposing factors of CVST in a series of 43 patients. Subjects and Methods: We conducted a retrospective study including 43 patients with confirmed diagnosis of CVST, admitted at Hamad Hospital, Doha, Qatar, between January 1, 2008, and December 30, 2011. Results: We identified 43 patients with CVST, the mean age of the patients was 34.3 ± 12.3 years (range: 17–82 years). There were 29/43 (67.4%) males and 14/43 (32.6%) females. The most frequent predisposing factor of CVST was local infection in 13/43 (30.2%), the mean duration of symptoms before presentation was 7.7 ± 9.5 days (range: 1–42 days), and the most common presenting symptom was headache found in 41 (95.3%) patients with the superior sagittal sinus being involved most frequently in 36 (83.7%) patients. The case fatality rate was 4.6%. Conclusion: In our hospital, CVST affects males more than females, with infection being the main predisposing factor and a mortality of 4.6%. Further prospective studies are needed to explain the predominance of infection as a predisposing factor.

Background: According to the World Health Organization recommendations, every country should have its own national immunization program for children to protect them against vaccines preventable diseases. This study aims to assess parental factors affecting the child's immunization status. Subjects and Methods: A descriptive, cross-sectional study was conducted on 419 parents attending maternal and child health (MCH) at El-hadaeq health center in Benghazi to vaccinate their children during November 1, 2016 to January 31, 2017. Results: Mothers constitute 79% of the study population and 53% of the children were male. Almost all the parents 402 (96%) were aware and had good knowledge about the national immunization program. Nearly 86% of the children were completely immunized for their age, and the main reason for missing vaccination is the unavailability of vaccines in MCH clinics. Conclusion: Although the awareness rate about immunization is high between the parents, there are still some children missed vaccinations. More educational interventions are therefore needed to increase and update parents' knowledge, and more emphasis on the local health authority is needed to ensure continuous vaccines supply to all MCH clinics and health centers in Libya.

Follicular thyroid carcinoma (FTC) is considered to be a well-differentiated thyroid carcinoma since it shows a low progression. Metastases occur in advanced stage by hematogenous route. Lung and bone are the two most common sites of metastases. In most of the reported cases of FTC metastasizing to the skull, metastases occurred long time after the diagnosis and establishment of adequate treatment for the primary cancer. Very few cases have been reported with FTC presenting as skull metastasis. We report the case of a 35-year-old female patient presented with a massive swelling of the right parietal skull region. Histopathologic examination confirmed that it is a FTC bone metastasis. A gross total resection of the tumor was performed. Two months later, a total thyroidectomy and lymph node resection were performed. The patient underwent radioactive-iodine (RAI) therapy and was given adjunctive Levothyroxine therapy. Five years of follow-up did not show any recurrence of the disease. Correct diagnosis of skull metastasis from preoperative FTC is difficult because of its rarity. Patients can survive several years after the therapy including total resection of metastatic tumor, radical operation of thyroid carcinoma, and adjunctive therapy by Levothyroxine and RAI therapy.

A 41-year-old male patient admitted with the complaints of fever, dizziness, abdominal pain, and scrotal swelling over the last 2 months. Clinical examination and laboratory tests revealed evidence of meningitis, pancreatitis, left sacroiliitis, and epididymo-orchitis. Blood culture revealed Brucella species and serology showed very high antibody titer against Brucella melitensis and B. abortus. The patient was started on ceftriaxone, doxycycline, and rifampicin, after which his general condition improved. He was discharged to continue intravenous antibiotics for 2 weeks after normalization of cerebrospinal fluid in addition to continuation of oral antibiotic for a total course of 6 months.

We report a case of Haemophilus parainfluenzae pyogenic liver abscess in a 53-year-old Filipino female who was admitted with a 3-day history of abdominal pain and fever. Clinical examination showed tenderness in right hypochondrium, and the liver edge was just palpable. Abdominal ultrasound revealed heterogeneous lesion in the left liver lobe, consistent with liver abscess, which was aspirated and the patient received ceftriaxone and metronidazole empirically. Two days after admission, pus culture grew profuse growth of H. parainfluenzae which was sensitive to ampicillin and ceftriaxone, accordingly metronidazole was stopped and ceftriaxone was continued 2 g daily intravenously. The drain was removed on 14^th hospital day. Patient made a good recovery and was discharged home on oral cefuroxime for 2 weeks more.