Objectives: The aim of this study was to describe gender differences in stroke risk factors, clinical presentation, and outcome in Qatar. Subjects and Methods: This is a secondary post hoc analysis of our previous prospective observational hospital-based study with new objective. Results: Among the 270 patients involved in this study, there were 198 (73%) males and 72 (27%) females. Two hundred and seventeen (80.4%) patients had ischemic strokes, whereas 53 (19.6%) patients had hemorrhagic stroke. Patients with hemorrhagic stroke showed no significant gender difference in their stroke profile. On the other hand, male patients with ischemic stroke were more likely to have had a history of hypertension (P < 0.001), smoking (P < 0.001), and daily alcohol drinking (P < 0.001), while female patients were more likely to have had a history of diabetes mellitus (P < 0.001). Moreover, dysarthria, swallowing problems, and gait imbalance were observed with high frequency in male patients, while headache was significantly associated with females (P < 0.001). Posterior circulation stroke syndrome was observed more in male patients, whereas female patients tend to have had partial anterior circulation syndrome. In-hospital mortality rate showed no sex differences in both hemorrhagic and ischemic strokes. Conclusions: No gender differences were found in patients with hemorrhagic stroke, whereas in patients with ischemic stroke there were significant gender differences in risk factors and clinical presentation except for fatality rate.

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Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) emerged in China in late 2019 and became a global pandemic by March 2020. SARS-CoV-2 is a highly transmissible virus that causes a clinical illness known as Coronavirus Disease 2019. The clinical spectrum ranges from mild respiratory and generalized symptoms to severe pneumonia with multiple organ failure. Overall mortality is high in older patients and those with comorbidities such as obesity and cardiovascular disease. Diagnosis is usually confirmed by polymerase chain reaction on upper or lower airway samples. Clinical management is largely supportive; no specific therapeutic options are currently available. Public health interventions have thus far been centered around social distancing, large-scale testing, and isolation. An unprecedent global effort has been mounted for the rapid development of effective SARS-CoV-2 vaccines. Until such time, further waves of SARS-CoV-2 are likely, if the restrictive control measures are removed.

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Background: This study was conducted to investigate the presence of Bacillus cereus in meat, meat products, and some seafood in Libya. Materials and Methods: One hundred and thirty-one samples were collected from different geographic localities in Libya. The samples were subjected to microbiological analysis for enumeration and isolation of B. cereus by conventional cultural, biochemical, and molecular identification using polymerase chain reaction (PCR) and partial sequencing of 16S rDNA techniques. Results: Of 131 samples, only 38 (29%) isolates were found to be B. cereus based on their cultural characteristics on Mannitol Egg-Yolk Polymyxin (MYP) medium that included 30% beef, 38.2% beef products (minced, burger, kabab, and sausage), 31.8% camel meat, and 48% chicken products (burger, sausage, kabab, and liver). However, B. cereus was not detected from mutton and seafood samples. Seventeen isolates were subjected to molecular identification using PCR and partial sequencing of 16S rDNA technique and confirmed to be B. cereus. The confirmed B. cereus strains were tested for their antibiotic sensitivity profiles and showed a high percentage of multiresistance phenotype. Conclusions: The results provide a better understanding of B. cereus isolated from food of animal origin in Libya and suggest that meat and meat products might play an important role in the spreading of B. cereus through the food chain with antimicrobial resistance characteristics.

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Infertility is a worldwide health issue with high impact on the individuals involved and the society as a whole. Estimates of infertility are very important to inform social and economic policies. The aim of this systematic literature review is to estimate the prevalence of primary and secondary infertility in Middle East and North Africa (MENA) region and produce the overall estimate of the different indicators of infertility in MENA region. A systematic search was conducted to identify publications providing data from MENA countries. All titles and abstracts retrieved using this search strategy were managed by Endnote software, duplicates were removed and studies on animals, systematic reviews, and from non-MENA region was removed from the EndNote library. Seven electronic databases and websites were searched for relevant articles and surveys with no language or date restriction on July 2017. Data of prevalence, risk factors, and causes of infertility were extracted from included articles and meta-analyzed to produce the overall effect sizes of the infertility estimates. Eight cross-sectional studies and one World Health Organization report contained the prevalence data from four MENA countries were included in this study. The clinical primary infertility defined as "the failure to become pregnant after 12 months or more of continuous and unprotected sexual intercourse" was estimated in 5 surveys as 3.8% (95% confidence interval (CI) = 1.7–8.4, effect size = −7.564, P = 0.0001), with the total clinical infertility, both primary and secondary infertility, estimate was 17.2% (95% CI = 10.6–26.7, effect size = −5.5, P = 0.0001). Demographic primary infertility was 22.6% (95% CI = 13.4–35.5, effect size = −3.8, P = 0.0001) and demographic total infertility rate was 38.5% (95% CI = 28.8–49.2, effect size = −2.11, P = 0.035). The data extracted suggested, overall, that clinical primary infertility is low at 3.8% and demographic infertility in MENA region is high, at 22.6%.

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Background and Aims: Cancer incidence rates are increasing in developed and developing countries. In Libya, it is vital for policymakers to know basic cancer epidemiology in each region of the country to design broad cancer prevention plans. This study aimed to determine the incidence rates (age-standardized) of different cancers in the western region of Libya. Materials and Methods: All histological proven cancer cases recorded in the cancer registry of Pathology Department at the Tripoli Medical Center (TMC) during the year 2009 were evaluated. Data were included demographic characteristics, such as age, sex, residence, date of diagnosis, and histopathological diagnosis, which were coded using the World Health Organization's International Classification of Diseases-10^th Revision. Cancer cases from outside the western region of Libya were excluded from the study. The incidence rates of cancer cases were standardized with reference to the age and sex distribution of the total regional population of Libya which was calculated based on the real census performed by Libyan statistics authority in 2006. Results: A total of 1013 patients were diagnosed and registered with cancer at TMC. Male accounted for 48.3% (489 patients) of the cases, and females for 51.7% (524 patients), with M:F ratio of 1:1.07. The overall mean age (±standard deviation) at the time of the first diagnosis was 52.01 ± 20.36 years. The most frequent cancers in both genders were as follows: breast (10.8%), colorectal (10.7%), lung (9.2%), lymphoma (8.5%), and leukemia (8.3%), whereas in males, lung (14.1%), colorectal (11%), leukemia (9.4%), lymphoma (9%), and prostate 7.6%) and in females, breast (20.6%), colorectal (10.5%), lymphoma (8%), uterine (7.4%), and leukemia (7.3%). Conclusion: Breast cancer was the most common cancer in females and lung cancer in males followed by colorectal cancer in both sexes. The information presented in this study can contribute to a better understanding of the epidemiology of various cancers in Libya and consequently, it provide a useful guide for the decision-makers to construct efficacious decisions about cancer control in Libya.

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Background: Rotavirus causes a significant proportion of diarrheal disease among young children worldwide. However, there is limited knowledge about the epidemiology of rotavirus in Libya. This study aimed to quantify the burden of rotavirus diarrhea among children under age 5 years. Materials and Methods: A prospective cross-sectional study was conducted in Almarj city between January 2011 and March 2012. Stool samples were obtained and tested for rotavirus from children <5 years admitted to the main public hospital for diarrhea. Patients with rotavirus were characterized by clinical symptoms; duration of diarrhea, fever, vomiting, and dehydration. Analyses of positive rotavirus patients were further stratified by breastfed versus bottle-fed children. Results: Rotavirus accounted for 57.4% of 270 diarrhea cases admitted to Almarj hospital. Rotavirus cases were more likely to be younger than 1 year of age (74% in rotavirus positive). Rotavirus patients commonly had symptoms 6 days (65%), and presented with vomiting (69%), high fever was uncommon (13%), and 42% had a normal temperature. Dehydration was common; moderate dehydration was seen in 79% of patients and 12% were severely dehydrated. About 89% of children infected by rotavirus cases were fed by bottle. Conclusion: There is a high burden of rotavirus in Almerj city located in North-Eastern region of Libya. While breastfeeding is recommended to reduce risk; increasing coverage of the rotavirus vaccine in children is likely to be the most effective and cost-effective strategy.

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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.

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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.

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Snakebite is prevalent in some communities in Nigeria. Unfortunately, some patients still find it difficult to readily assess health care, resulting in late presentation, whereas others will prefer to use traditional remedies, only seeking orthodox care late after experiencing failure of traditional remedies; this accounts for significant increase in cases of complications and mortalities witnessed. Therefore, the case of an 8-year-old boy who had carpet viper bite on the right hand that developed gangrene due to late presentation is highlighted.

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Planar scintigraphy using technetium-99m pertechnetate is widely used in the diagnosis of Meckel's diverticulum. Single-photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging may help to localize the Meckel's diverticulum lesion. We present a case of a 19-yearold lady with recurrent lower gastrointestinal tract bleeding. She underwent Tc-99m pertechnetate scintigraphy. The planar images showed two foci of increased uptake located in the lower abdomen and at the level of the right kidney. The one located at the right kidney level could be physiological uptake or by an ectopic gastric mucosa. Using SPECT/CT technique, we confirmed that the lower part of the concentration was from a Meckel's diverticulum from the small intestine based on the functional and anatomical information together; however, the upper uptake was physiological right proximal ureteric uptake. Our case study suggests that SPECT/CT imaging needs to be considered to obtain a definitive diagnosis, mainly with cases with ambiguous planar scintigraphy images.

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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.

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Background: Peptic ulcer is a gastrointestinal disease characterized by mucosal damage. The study is aimed at evaluating the gastroprotective effect of Nigella sativa seed extract in rats. Materials and Methods: Twenty rats were divided into four groups of five rats each and were fasted for 18 h. Rats in Groups 1, 2, 3, and 4 were pretreated with normal saline, gestid, and N. sativa extract at 320 mg/kg and 640 mg/kg, respectively, 30 min before administration of 80% ethanol. All the rats were sacrificed after 1 h and the stomachs were cut open. The stomachs were examined for macroscopic lesions and processed for light microscopic study. Results: There was a significant decrease in ulcer index of rats pretreated with gestid suspension, 320 and 640 mg/kg of N. sativa extract as compared to those of rats pretreated with normal saline at P < 0.05. The stomach of rats pretreated with normal saline showed mucosa full of lesions, those of rats pretreated with gestid suspension showed very few vascular congestion, while those of rats pretreated with 640 mg/kg of N. sativa showed few vascular congestion. Photomicrograph of the stomach of rats pretreated with normal saline showed vacuolation of basement epithelium while those of rats pretreated with gestid suspension and N. sativa extract showed normal basement epithelium. Conclusion: N. sativa seed extract was able to protect the stomach mucosa from gastric ulceration.

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Background: The prevalence of hepatitis C virus (HCV) infection in Libya is 1.3%. It is considered now a curable disease due to the availability of effective DAAs which open a new horizon for HCV elimination. The aim of this study was to evaluate the efficacy and tolerability of ledipasvir/sofosbuvir (LDV/SOF) (Harvoni) on patients with chronic hepatitis C infection. Patients and Methods: The cohort comprises 266 HCV-infected patients followed from May 2016 to October 2017. The inclusion criteria were treatment experienced or naïve and 18 years or older. Cirrhotic patients included were Child–Pugh A and B whereas Child–Pugh C patients were excluded. All patients had been treated with LDV/SOF 90/400 mg. The primary endpoint was sustained virological response (SVR) at week 12 and significant adverse events. Results: Of 266 patients who participated in the study, it's found that 126 were males(47.3%) and 140 were female (52.7%). The average age of the patients was 45 years for both genders. Ninety percent of patients were Libyan. The predominate genotype was 4 (81.3. %), genotype 1 (15.3%), and genotype 2 (3.2%). One hundred and seventy-eight (66.9%) patients were treatment naïve and 88 (33.1%) patients were treatment experienced. Alanine aminotransferase elevated in 37% of patients at baseline. HCV RNA >5 log at the start of treatment was found in 67.2% of patients. Eighty-eight patients were cirrhotic. The adverse effects of the drug were reported in 38/266 (14.2%); the most commonly reported side effects were headache, gastrointestinal upset, and dizziness, whereas hepatic decompensation occurred in 5 patients and all were cirrhotic. Undetectable viremia at the end of treatment (week 12) was observed in 263 patients (98.5%) and 3 patients have been labeled as nonresponders. SVR at week 12 was available in 263 patients and achieved in 261 patients (98.1%), and only two relapsed. Conclusion: Excellent treatment outcomes among our cohort of HCV-infected patients were achieved with LDV/SOF. Testing for chronic HCV patients and availability of care will help in cure and a step toward eradication of HCV in near future.

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Background/Aims: Data on the prevalence of hepatitis C virus (HCV) infection in Libya, and particularly among hemodialysis patients, are scarce. The aim of this study was to assess the prevalence of HCV infection among hemodialysis patients at 37 dialysis centers in Libya and review the demographic features in this group of patients. Patients and Methods: The present cross-sectional study included a total of 2325 patients who had spent at least 3 months in hemodialysis at 37 dialysis centers in different cities across the three main regions of Libya (Western, Eastern, and Southern regions). There were 1028 (44.2%) female and 1297 (55.8%) male with mean age 53.4 ± 15 years. Hypertension (36.4%), diabetes mellitus (33.3%), renal diseases (10.9%), genetic diseases (7.5%), and unclear reasons (12%) were diverse underlying causes of end-stage renal disease in these patients. Anti-HCV antibody was screened by a third-generation enzyme-linked immunosorbent assay technique. Results: The overall seroprevalence of HCV infection among hemodialysis patients in Libya was 16.7% (388/2325), ranging from 0% to 26.3% at different centers. The overall frequency of anti-HCV antibodies was higher in Western region (18.9%) than Eastern (18.3%) and Southern (6.1%) regions of Libya. It is noteworthy that the prevalence of HCV was 0% in numbers of dialysis centers across the three regions. The duration of hemodialysis was significantly longer in HCV-positive hemodialysis patients than in HCV-negative patients (P = 0.01). Hepatitis B surface antigen was positive in 92 hemodialysis patients (4%), of them 8 patients (8.7%) had coinfection with HCV infection. Conclusion: The present study showed an intermediate-prevalence rate of HCV infection among hemodialysis patients in Libya. The relatively low prevalence of HCV infection in the general Libyan population and HCV infection associated with a longer duration of hemodialysis indicate nosocomial transmission due to inappropriate infection control practices as the main HCV route of infection in these health-care settings.

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Background: Pharmacovigilance for pediatric drug therapy is lacking among Libyan patients. Hence, pediatric patients are at risk of unpredictable drug effects as a result of prescription fault. Therefore, this study was aimed to determine the drug prescribing errors for children attending the pediatric outpatient clinic at Tripoli Children Hospital, Libya. Materials and Methods: A retrospective study was carried out using the given prescription for patients who attended the hospital between July 2 and November 30, 2012. Patients aged below 13 years were included in the study. Drug use indicators were assessed using the British National Formulary guidelines. Results: There were 600 prescriptions (75.9%) collected for both, female patients (303 prescriptions, 50.5%) and male patients (297 prescriptions, 49.5%) with a total of 1167 prescribed drugs (on average 1.9 ± 1.2 items/prescription). Five hundred and eighty-six prescriptions are found which had at least one type of error, and this correlated with increased number of drugs per prescription. The error rate was 97.7%. Prescribing by inadequately dosing was done in 3.3% of all the prescribed medications, while 3.8% had inadequate durations. Furthermore, diagnosis, dosage, frequency, duration, and instruction were omitted in 96.5%, 5.7%, 10.2%, 42.8%, and 89.6% overall prescribed drugs, respectively. Drug–drug interactions were found in 63 prescriptions (10.5%) and involved mostly antiepileptic medications. Conclusion: Our study demonstrates that pediatric patients are at high risk of both, treatment failure, and adverse drug reactions. Hence, pharmacovigilance for pediatric prescriptions is critically needed. As well, a continuous medical education, in particular rational drug prescription, with much focus on the pediatric doctors, is strongly recommended.

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Background and Aim: Cesarean section (C-section) is a surgical intervention, which is carried out to ensure the safety of mother and child when vaginal delivery is not possible or when the doctors consider that the danger to mother and baby would be greater with vaginal delivery. The prevalence of cesarean section has been increasing in developed and developing countries. The aim of the present study is to determine the prevalence and indication of C-section and common indications in Al-Wahda Hospital, Derna, Libya. Patients and Methods: A retrospective study of medical notes and records was conducted at the Department of Obstetrics and Gynecology, Al-Wahda hospital, which is the only teaching and referral hospital in Derna. Initially, the case records of all women who gave birth at the hospital were retrieved from January 1, 2013, to December 31, 2016. Data were collected by trained data collectors using a standardized paper form and then entered into an electronic database. Results: The overall rate of C-section in Derna city was 23.5%. The age of mothers who give a birth by C-section ranged from 15 to 49 years with mean ± standard deviation of age 31.4 ± 6.06 years. The most common indications were elective repeated caesarean section (23.3%) follow by fetal distress (16.5%) and previous one caesarean section with other cause (11.5%). Conclusions: The overall rate of C-section in Al-Wahda Hospital was 23.5%. This rate is high than the World Health Organization standard.

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Background and Aim: Pterygium is a relatively common condition of the conjunctiva that affects people at different stages of life. Dry eye disease (DED) is a well-known associated morbidity with pterygium. The aim of this study was to investigate the association between pterygium and dry eye among otherwise healthy Libyan people. Methods: A case–control study was conducted on patients attending Al-Keish Polyclinic in Benghazi. Two techniques have been applied individually, in parallel and in series for all of the study participants, Schirmer's test and break-up time (BUT) test. Results: This study included 50 eyes belonged to 35 patients with a median age of 37 (range 26–65) years, and among those, 18 (51.4%) cases (25 eyes) had pterygium and a group of 17 (48.6%) cases (25 eyes) were control. Rates of DED diagnosis were highest using parallel testing (positive results in any of the tests) than with BUT and Schirmer's test individually and lowest using series testing (positive results in both tests). Eyes with pterygium showed obviously and statistically significant higher rates of positive test results. All controls were normal testing with Schirmer's test and hence in series testing. Conclusion: Testing for DED using parallel combined testing (BUT and Schirmer's test) relying on positive result of any of the tests increases sensitivity and may increase the value of the test for screening for dry DED among particular high-risk groups.

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Coronavirus disease 2019 (COVID-19) has emerged as a rapidly transmissible communicable disease around the globe. Diabetes is reported as a common morbidity in patients with COVID-19, has been associated with worse clinical outcomes, and may lead to higher mortality. Because the disease has variable presentations varying from mild respiratory symptoms to pneumonia and respiratory failure, proper care of patients with diabetes in this context should cover both outpatient and inpatient sectors. Outpatient management in acutely ill patients includes frequent home glucose monitoring; holding certain medications including metformin, sodium glucose co-transporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists that may cause unwanted side effects such as dehydration and resulting acute kidney injury; continuation and adjustment of insulin therapy; and patient education on indications to seek medical assistance. Inpatient glucose management of patients admitted with COVID-19 involves holding noninsulin medications, monitoring blood glucose, and starting insulin if glucose levels are not in target. Intravenous insulin is recommended for critically ill patients with uncontrolled glucose. Universal measures should include assurance of continuity of care, adherence to therapy, and self-management education using connected health models and telemedicine. Patients with diabetes are considered a vulnerable group during periods of epidemics, and clear recommendations and pathways are essential to assure patients' safety.

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Background: To improve the efforts that try to detect the common risk factors of postoperative nausea and vomiting (PONV), this epidemiologic survey was designed to evaluate the present incidence of PONV for different types of common surgical procedures among patients of Tripoli Medical Center, Tripoli, Libya. Methods: Over a period of 6 months, the prospective interview-based survey included more than 170 elective surgical inpatients aged between 18 and >65 years and received general or regional anesthesia was done by the authors. Results: Among the 170 patients surveyed in this study, the incidence of PONV at the recovery room was 28.2% and 22.3%, respectively. Over the whole 24 h period, the incidence of PONV was gradually increased to 32.3% and 25.8%, respectively. The highest prevalence of PONV was observed in the gynecology patients. Female patients were suffered from both nausea and vomiting more than male patients. Besides, PONV in patients who received general anesthesia was much more common than those who received regional anesthesia in both observation periods (the recovery room and the ward). Conclusion: Our study shows various risk factors of PONV. These factors could help to increase the possibility of recognizing patients at risk for PONV.

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Background: Carbapenemase producing bacteria are a serious public health concern and further pressure on the last-resort antimicrobials. Objectives: The aim of the study was to investigate the molecular characteristics of 48 multi-resistant Enterobacteriaceae isolates recovered from clinical samples. Materials and Methods: Isolates were investigated by antimicrobial susceptibility testing and polymerase chain reaction protocols for bla_OXA-48and metallo-beta-lactamase genes. Results: Klebsiella pneumoniae and Escherichia coli isolates demonstrated high frequencies of multidrug resistance and various phenotypes. Eleven K. pneumoniae carried extended-spectrum β-lactamases genes of which four strains possessed both OXA-48 and New Delhi metallo genes. Conclusion: Carbapenemase-producing bacteria in the Libyan health system warrants further attention and are possibly underestimated. Urgent control and prevention actions are required.

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