COVID 19 pandemic in 6-8 months has left many countries in a devastating state , it has caused mortality and disabilities with different mechanism in the body which have been continuously evolving since the origin of the SARS COV2 virus causing great social, psychological and financial burden on the countries around the world. As we all know it's a viral infection with been different theories suggesting different action of SARS COV2, which have been evolved in last few months and still its ongoing to understand the exact nature of its virulence with its involvement of different mechanism of actions in different population which not only makes difficult in clinical prediction , prognosis but also its utmost challenging in the management and treatment of COVID 19 infection. In our review article we mainly emphasize over the recent updates involved in different action of SARS COV2 infection on different organs of human body, its virulence variation in selected populations, clinical predictors. We also briefly discuss about the latest modality of management for SARS COV2 infection along with treatment regimens and updates on vaccination.

At present, no African country is spared of COVID-19 infection, with existing weak health systems, significant limitations are unsurprisingly encountered in response capacity to the pandemic. Health systems are stretched, leaving health-care workforce vulnerable to infections, yet not protected and motivated, but left to pay the highest price for the decades of neglect of public and occupational health services in many African countries. Healthy frontline health-care workers are pivotal to the success and sustenance of the prevention and control of the COVID-19 pandemic, hence the need to urgently protect them. African governments need to take responsibility to prevent work-related COVID-19 infections among health-care workers. Beyond the current pandemic, African governments should elevate the right to health topmost in their policies and programs to improve people's lives, including health-care workforce.

Background/Aim: The coronavirus disease 2019 (COVID-19) pandemic, also referred to as the coronavirus (CoV) pandemic, is an ongoing outbreak of COVID-19. It is caused by severe acute respiratory syndrome CoV 2. Health-care workers (HCWs) are at amplified risk of infection of CoV due to the nature of their work. This study aims to evaluate the knowledge, attitude, and practice toward (COVID-19) among Libyan HCWs. Materials and Methods: A cross-sectional survey was carried out from the 5^th until the 15^th of April 2020; data were collected through an online questionnaire. The study sample was not restricted to specific cities; any Libyan HCW could join. The 318 participants were Libyan residents from the various cities who had completed the online questionnaire. Results: The majority of participants were from the capital Tripoli (34.9%), Zawia (32.4%), and Benghazi (9.1%). More modest rates of responding HCWs were divided among 27 other Libyan cities. Of the participants, 79.9% were positive they have sufficient information about COVID-19, and 69.8% were following updates regarding the outbreak. Their main sources of information were health-care providers (33.3%), social media (30.2%), and journal articles (29.2%). Conclusion: Most of the Libyan HCWs had good knowledge for virus, and the knowledge scores were significantly associated with the age difference. In addition, they had a positive attitude for COVID-19. The findings will assist authorities to establish the essential educational programs to provide advanced learning by providing necessary recommendations and deliver the best practice to control the pandemic. Essentially, these procedures will ensure their health and safety.

Background/Aim: Breast cancer is the most common cancer in Libyan women. Studies of breast cancer risk assessment in Libyan women are not available, and it is important to detect people at high risk for preventive and screening measures. The aim of this study is to estimate the 5-year and lifetime risk of breast cancer in Libyan women using the Gail model. Subjects and Methods: This cross-sectional study was conducted on 918 Libyan women ≥35 years. The Gail model was used to calculate the 5-year and lifetime risks of developing breast cancer. Risk factors such as age at menarche and first live birth, number of previous breast biopsies, family history, and ethnicity were considered in the model. Results: The mean age of women was 46.9 ± 8.7 years. The mean 5-year and lifetime risks were 1.0 ± 0.6 and 10.7 ± 4.8, respectively. A significant correlation was found between 5-year and lifetime risk and age at menarche, family history, previous breast biopsy, and ethnicity (P < 0.05). Conclusion: The risk estimates obtained from the Gail model could be improved if the risk factors involved are corrected for the Libyan population by conducting cohort studies with long follow-up to calculate the relative risks caused by each factor. In particular, the risk of different ethnic groups should be estimated and a modified model developed for Libyan women.

Objectives: Polycystic ovarian syndrome (PCOS) is thought to be a subclinical inflammatory state with increased levels of circulating pro-inflammatory cytokines. Midkine is a pleiotropic heparin-binding neurotrophic factor with pro-inflammatory properties, and growing evidence has shown a substantial effect of midkine in inflammation. This study aimed to test whether midkine has a role in PCOS development and its relation to obesity and insulin resistance (IR). Materials and Methods: In this comparative cross-sectional study, 56 women with PCOS and 36 eumenorrheic nonhirsute, age- and body mass index (BMI)-matched women as the control group were recruited. Routine and specific (midkine) laboratory analysis and IR measurements were applied to both the study groups. Results: There were no statistically significant difference between PCOS patients and controls with regard to serum midkine levels (P = 0.412). PCOS patients were further divided into two subgroups according to BMI levels. Serum midkine levels were found to be increased in overweight PCOS patients compared with normal-weight PCOS patients (P = 0.044). Although an increasing trend was observed in respect to serum midkine levels in PCOS women with IR (Homeostatic Model Assessment-IR ≥2.5), this elevation was not statistically significant (P = 0.301). Conclusions: The positive effect of obesity on midkine levels supports the idea that midkine is probably released from adipocyte cells. IR possibly has an important role in this mechanism.

Background: Epilepsy is a common neurological disorder with the first onset of seizure represents a common cause of emergency department visit. Objectives: The objective of this study is to provide the data as well as to assess our local clinical practice parameters regarding the management of patients with first-onset seizure. Patients and Methods: A retrospective study was carried out using the medical records at 7^th October hospital, included all patients admitted to the hospital with first seizure during the time period from “January 2013 to January 2014.” Results: Out of 145 patients presented with seizures, 52 (36%) patients presented with first seizure and admitted to the general medical ward and were managed by internist. The mean age of the study population was 45 ± 24 years, 26 (50%) patients were male. Thirteen (25%) patients had unprovoked seizure and 39 had provoked seizure with stroke being the most common cause. Brain scan and electroencephalogram were ordered in 28 (54%) and 16 (31%), respectively. Anti-epileptic drugs were prescribed to 32/52 (62%) patients, including all poststroke seizure patients and seven patients with unprovoked first seizure. Conclusion: We provided data regarding patients presenting with first seizure and insight into local practice regarding care of this group of patients. To our knowledge, such data were not reported before from our area. The findings were partly in agreement with evidence-based practice, though justification was still needed. The larger and more constructed study is warranted as “First Fit Presentation” is one of the common presentations in the emergency department.

Breathlessness was the common presenting symptom, but combined spontaneous–pneumothorax–pneumomediastinum–subcutaneous emphysema (SPPSE) is not known complication of coronavirus disease-2019 (COVID-19) pneumonia. We are report a case of CSPPSE in a male adult with previously healthy lungs infected with COVID-19 pneumonia. On May 16, 2020, he was presented to the Emergency Department of Hamad General Hospital, complaining of fever, leukocytosis, and normal CRP. Chest X-ray showed mild COVID-19-related pneumonia. He was started on the local Qatari-recommended protocol for COVIMD-19. Suddenly, his oxygen saturation was deteriorated and transferred to the medical intensive care unit where he had noninvasive ventilation. Chest X-ray showed right pneumothorax, but there was no evidence of pneumomediastinum or subcutaneous emphysema. On May 30, chest computed tomography was conducted and did not show any evidence of chronic lung diseases that can produce CSPPSE. Finally, on June 13, the patient was labeled as recovered COVID-19 patient. CSPPSE is a complication of COVID-19 pneumonia, even in previously normal lungs.

Kidney transplant kidney transplant (KTx) recipients have increased susceptibility to a spectrum of infections including; bacterial, viral, and fungal pathogens. Many factors contribute to their infection potential risk, in terms of their immunosuppressive state, that result in suppression of their B-and T-lymphocyte repertoire, also to consider certain donor and recipient-related factors, that make them at risk of specific type of infectious complications. In addition kidney transplant patients tolerate poorly infections, which may adversely affect their graft function, by inducing glomerular injury, hence early diagnosis, directed therapy, and careful dosing of antimicrobial agents is of paramount importance in reducing patient's morbidity and mortality. We report a kidney transplant patient, who received her live related kidney graft 7 years earlier (in 2013), she has been with stable graft function in most of her follow up period, until she presented with pyrexia, dyspnea and fatigue associated with deterioration of her graft function.

Bloodletting as a treatment for various diseases is an ancient belief; nowadays, it is practiced in many communities, especially in Asia and the Middle East. Among others, cupping is one form of bloodletting procedure. We are presenting a patient with overvalued belief (idea), he relied on cupping as a therapy to treat his headache. For many years, cupping was done for him every few months, then he tried doing it himself, more frequently. Thereafter; cupping sessions dominated his life in a way that he used to do it every few days and whenever he felt a headache. Over the years, the patient sustained severe anemia, although it was self-induced; however, it was not factitious as his intention was to cure himself rather than inducing self-harm. Management was a challenge as it was difficult to convince him to stop this practice and to consult psychiatrist.

Disseminated fungemia due to non-Candida yeasts is emerging as an opportunistic infection in hematological malignancies with prolonged neutropenia. Invasive infections by Geotrichum spp. are extremely rare and constitute only about 1% of all non-Candida yeasts. The mortality in such patients is high and is seldom reported in the literature. Here, we describe the case of a middle-aged male with treatment-resistant Hodgkin's lymphoma who developed invasive Geotrichum capitatum infection during his neutropenic phase, with poor response to combination therapy with voriconazole and amphotericin B. He was diagnosed from blood culture but succumbed to death on day 10 of admission in spite of treatment with multiple lines of antifungals. G. capitatum is responsible for fatal fungemia in patients with prolonged neutropenia complicating hematological malignancies. A high index of suspicion is required in this patient group to identify disseminated geotrichosis as delay in treatment worsens mortality.

The 1^st confirmed Covid-19 case in Libya was reported from Tripoli on March 25, 2020. However, as of May 21, 2020, Libya has 69 confirmed cases, which is a very small number of cases in comparison to the rest of the world. This report describes the 1^st cluster of confirmed Covid-19 cases in Benghazi, Libya, which was discovered during the 7^th and 8^th of April 2020. The clinical, biological, and radiological characterestics of a cluster of four cases (primary case and three secondary cases) were described in this report. Among the four confirmed cases, two were asymptomatic, one symptomatic and one presymptomatic. The transmission rate in this cluster was three, and the secondary attack rate among the household contacts was 37.5%. None of the four cases was severe and all of them recovered without complications. this preliminary experience is in concordance with the reports from the other parts of the world.