Background/Aims: Healthcare professionals (HCPs) are among the frontlines of the battle against the Coronavirus Disease-2019 (COVID-19) pandemic. Adequate knowledge of prevention and treatment practices, alongside a positive and forward attitude, are all essential for the success of the defense against COVID-19. We aimed to scope the knowledge, attitude, and practices of HCPs toward the COVID-19 pandemic at its peak time from 2 developing regions: the Middle East and North Africa (MENA). Materials and Methods: We utilized an online, electronic survey consisting of a multiple-choice questionnaire including three domains: Knowledge, attitudes, and practices, targeting a convenience sample of HCPs from the MENA region. Results: Three hundred and seventy-four respondents were included in the analysis; 68.7% resided and practiced in the Middle East, while 31.3% were from North Africa. The majority (71.2%) had postgraduate degrees and were either hospital or non-hospital doctors. Regarding basic knowledge, the majority recognized the main clinical symptoms of COVID-19 and that there was no effective antiviral treatment at the time. The majority also recognized the role of supportive measures, social distancing, isolation, and treating those infected as effective ways to reduce the spread of the virus. In addition, respondents reported that through a general curfew, social distancing was either very effective (65.8%) or effective (31.9%). Respondents were mainly worried about the health of their family members, the risk of contracting the coronavirus, and the economic situation of their family. Two-thirds considered the government's reaction to the current pandemic appropriate, while about one-fifth (21.2%) reported it somewhat insufficient. However, high levels of confidence were reported in countries' abilities to control the pandemic successfully. Regarding practices, 18.5% reported having been too crowded recently, and 16.5% admitted having not worn a mask when leaving the house. Preventative measures varied widely; the best was reported for washing hands more frequently than before (80.3%), while the worst was for the likelihood of informing people around an individual if he/she developed symptoms of sickness (56.1%). Conclusions: HCPs exhibited a reasonably high level of basic knowledge about the COVID-19 pandemic in its early months. Despite a reportedly positive attitude toward the preventative measures, these were not matched by equally strict individual behaviors.

Background: Measles surveillance program plays an essential role in determining disease prevalence data and outbreaks as well as monitoring the preventive activities toward measles elimination. This study illustrates epidemiological measles indicators through the national measles surveillance program in Libya in the year 2018. Materials and Methods: Annual measles surveillance report in 2018 was analyzed to figure out the spread of measles disease. Case-based surveillance is being implemented to notify suspected measles cases (skin rash and fever) through the measles surveillance system. The program depends on immediate notification of suspected measles cases and blood sample collection by official measles surveillance officers covered most health facilities in the country. National measles laboratory is the only official institute authorized to confirm measles cases. The characteristics such as the number of confirmed measles cases, deaths, age group, measles trends, and vaccination status were analyzed to find the indicators, as well as the incidence rate of measles cases was calculated nationwide. Results: Total number of measles cases was 1059 confirmed from 1852 suspected measles cases. Of confirmed cases, 339 were laboratory confirmation and 720 were epi-linked, with limited deaths (2 cases) were registered in the year. Seven outbreaks were detected in several locations. The age group of most cases (86%) was below 3 years of age group. Measles incidence was 152 per million which higher than previous years and comparable to many neighboring countries. The measles vaccine was not reached to 47% of suspected cases. Seasonality of measles was not in normal trend as it was continued high even in the summer month. Conclusion: A significant measles burden was shown through the measles surveillance system even though high measles vaccination coverage rate was officially documented. Supplementary immunization activities should be an essential action point to mitigate measles morbidity.

Background: Many epidemiological studies reported the association of Vitamin D deficiency and abnormal liver enzymes' levels with type 2 diabetes (T2D) and their findings remain inconsistent. Aim: The study investigated the status of both Vitamin D levels and liver enzymes' activity in a Libyan population with T2D. Materials and Methods: A total of 180 individuals of both genders whose ages ranged between 25 and 62 years were enrolled. Fasting blood sugar, (FBS), Vitamin D, aspartate aminotransferase (AST), alkaline phosphatase (ALP), and alanine aminotransferase (ALT) were measured in patients' serum. The association of both Vitamin D and liver enzymes levels with T2D was evaluated by Chi-square analyses. Results: 55.6% of the study subjects were diabetics and 44.4% were healthy controls. 100% of T2D patients had deficient Vitamin D level (<20 ng/ml) (P = 0.000). The mean Vitamin D level was higher in nondiabetics (39.1 ± 4.0) ng/ml than in T2D patients (7.4 ± 1.8) ng/ml. 98% (P = 0.068), 97% (P = 0.118), and 100% of T2D patients had normal levels of AST, ALP, and ALT enzymes, respectively. The mean AST, ALP, and ALT enzymes levels for nondiabetics were 30.3 ± 4.1, 58.7 ± 8.0, and 24.8 ± 4.9 U/L, respectively. The mean AST, ALP, and ALT enzymes levels for T2D patients were 11.3 ± 2.9, 125.0 ± 11.5, and 10.3 ± 1.7 U/L, respectively. Conclusions: Vitamin D deficiency may be related to T2D in the Libyan population, while the liver enzymes showed no significant differences between diabetics and nondiabetics.

Background: Histopathological examination of endoscopic biopsy specimens support diagnosis, monitoring the course of the diseases and recognize complications. The aim of this study was to determine the type and frequency of histopathological change in colonic biopsies and its correlations with age and sex. Materials and Methods: Two hundred and fifty-eight colonic biopsies were collected from January 2016 to December 2017. The tissue was subjected to histopathological examination, the data collected and statistically analyzed. Results: Neoplastic colonic lesions form 52% and nonneoplastic form 48%. Cases of adenocarcinoma form 39.1%, nonspecific colitis form 29.1%, adenoma form 12.8%, ulcerative colitis was seen in 7.4% of cases, hyperplastic polyps form 6.2%, and Crohn's disease from 5.4%. Most of adenocarcinomas were moderately differentiated, the grade was higher in females (P = 0.032). Most of nonspecific colitis cases showed mild inflammation. Most of the adenomas were tubular type. More than 90% of neoplastic lesions were in patients above 40 years and 45.5% of inflammatory bowel disease (IBD) cases were present in the age group of between 20 and 39 years (P = 0.001). Most of the cases of adenomas were seen in the age group between 40 and 80 years and (P = 0.018) Conclusion: Adenocarcinoma is the most frequent abnormality, mainly above 40 years of age. IBDs were seen below 40 years of age. In general, in all lesions, males were more affected than females except in cases of IBD and moderately differentiated adenocarcinoma.

Background/Aim: The absolute risk of death due to coronary artery disease (CAD) is two to five times higher in patients with diabetes than in those without diabetes regardless of the cholesterol concentration, and females with diabetes have the worst prognosis. The aim of the current study was to investigate the angiographic severity and extent of CAD in patients with Type 2 diabetes mellitus, compared with nondiabetic patients. Patients and Methods: A hospital-based retrospective cross-sectional study was performed on 340 patients who were diagnosed with CAD. The two groups were matched for age, gender, and other major risk factors. Data collected include demographic data, distribution, and extent of coronary artery involvement. Results: Three hundred and forty patients were included in the study, 175 of them (51.4%) were diabetics, and 165 (48.5%) were nondiabetics, comparing coronary angiographic results of both groups: One hundred and twenty-six patients (73%) of the diabetic patients have multivessel diseased (P = 0.003), 49 patients (27%) have a single-vessel diseased and none of them have a normal coronaries (0%). While for the nondiabetic patients 82 (50%) of them have a multivessel diseased, 63 patients (38%) have a single-vessel diseased, and 20 patients (12%) have normal coronaries. Conclusion: Multivessel disease with diffuse lesion is more prevalent among diabetic Libyan patients compared with nondiabetics. The affected vessels in diabetic patients are diffusely diseased more than nondiabetic.

Background/Aim: Veterinary medical personnel may carry important antibiotic-resistant organisms playing important role in their dissemination and emergence. The purpose of the study was to investigate nasal colonization and antibiotic resistance of Staphylococcus species isolated from veterinary personnel (VP). Methods: A total of 47 VP were sampled, whereby nasal samples were subjected to selective and typical laboratory protocols. Presumptive isolates were further confirmed and fully characterized by the Phoenix automated microbiological system then further tested by polymase chain reactions for mecA and panton-valentine leukocidin (pvl) genes. Results: A total of 34 (72%) VP were colonized with various species, mostly coagulase-negative staphylococci. A collection of 34 staphylococci isolates were collected of which 21% and 6% were, respectively, positive for mecA and pvl genes expressed exclusively by Staphylococcus aureus and S. epidermidis. Conclusion: VP may carry various staphylococci species of public health importance expressing multidrug resistant and virulent traits. Preventative measures and continuous monitoring are required to control the spread of methicillin-resistant staphylococci in veterinary clinics.

Since 2017, direct-acting antivirals (DAAs) are the first-line treatment for patients with chronic hepatitis C virus (HCV) infection. In hemodialysis (HD) patients, however, a small percentage of patients failed to respond, and the data for the treatment of DAAs for such patients with HCV are lacking. Herein, we report a 57-year-old Libyan female patient on regular HD therapy for 18 years who did not achieved HCV clearance 12 weeks after the treatment with sofosbuvir/daclatasvir. Later, she was treated with elbasvir/grazoprevir (EBR/GZR) for 12 weeks and achieved a sustained virological response at the end of the treatment (12 weeks) and 12 months after the end of the treatment. No obvious side effects were reported during the treatment. Thus, EBR/GZR was effective and safe in this hemodialyzed patient with HCV genotype 2b infection who was failed to respond to12 week-treatment with sofosbuvir/daclatasvir combination.

Hepatocellular carcinoma (HCC) is the leading primary malignancy of the liver and typically develops in the background of chronic liver disease, particularly those with cirrhosis due to viral hepatitis B and C. Ruptured tumor is the most serious complication of HCC primarily occurring in older patients with significant mortality rate. In this report, we present a case of acute abdomen with the features of impending shock as the first presentation of a spontaneously ruptured HCC in a previously healthy young man.