Peritoneal tuberculosis (TB) remains a public health problem especially in the developing countries, even in the developed countries, where the disease had been mostly controlled; it poses a new challenge for health-care facilities as a result of increased immigration from high prevalence area, the use of more potent immunosuppressive therapy and the acquired immunodeficiency syndrome epidemic. The diagnosis of peritoneal TB is often challenging and cannot be made or excluded on the basis of clinical findings, which are quite protean and nonspecific. Blood biochemistry, complete blood cell count, and radiographic studies are of limited diagnostic value. Acid-fast smear of ascitic fluid has a low yield and cultures require weeks to give results and are positive in 2%–50% of diagnosed cases. Polymerase chain reaction analysis for rapid detection of bacillus tubercles in ascitic fluid has low yield, and the role of other biomarkers such as adenosine deaminase and gamma interferon is less well described and currently being evaluated as diagnostic tools. Laparoscopy with directed biopsy provides a rapid and correct diagnosis in 76%–100% of cases and should be performed early in suspected cases. Six-month therapy with the 4-drug regimen is effective in most of the patients, while the role of adjunctive corticosteroid therapy remains controversial.

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Vitamin B12 deficiency is not an uncommon condition. Commonly patient presents with megaloblastic anemia and pancytopenia. There are reports in the literature of Vitamin B12 deficiency associated with other immunological conditions. We report such a case of Vitamin B12 deficiency associated with hemolytic anemia in a 36-year-old Indian man, who presented with pancytopenia and hemolytic anemia. Workup for other causes of hemolytic anemia was negative, and the patient responded to treatment with Vitamin B12, with resolution of pancytopenia and hemolysis. Clinicians need to be aware of this association as both conditions occur rarely together and unawareness may lead to unnecessary investigation and procedures.

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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: Hematuria is common complaint brings patients to a physician. Macroscopic hematuria can be transient or persistent, and it may or may not associate with significant urinary system abnormalities. Objective: The objective of this study is to determine the major causes of macroscopic hematuria in ages less 20 years. Patients and Method: Descriptive case series study carrried out as a collaborative study in Tripoli during Januray 2013 - December 2014. Patients who presented with macroscopic hematuria file were studied retrospectively for gender, age, possible associated diseases as glomerulalar diseases, urinary tract infection (UTI), and others. Results: Out of 126 patients had macroscopic hematuria, 107 patients had the required data that achieved the study protocol. They were 72 cases (67.28%) males and 35 cases (32.71%), and their age ranged between (7 and 20 years). Macroscopic hematuria was more frequently reported at the age 7–13 years, and it was reported in (58.87%) due to the glomerular lesion, and in (41.12%) due to nonglomerular cause. Acute poststreptococcal glomerulonephritis (AGN) was the most common cause of macroscopic hematuria (53.27%), UTI was the second cause of macroscopic hematuria (28.97%), and renal stone was (9.34%) of total causes. Macroscopic hematuria due to trauma reported in 3 cases (6.8%), and in 5 cases (2.27%) due to IgA nephropathy. Conclusion: AGN and UTI are common causes of macroscopic hematuria. Urine microscopic examination is essential to differentiate between them before preceding to the other complicated, expensive, and invasive investigations.

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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: 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 and Aim: Gastrointestinal (GI) symptoms are common in patients with chronic kidney disease (CKD), and upper GI endoscopy is a diagnostic tool for GI manifestations in this group of patients, but it is not always indicated. The aim of this study was to investigate the necessity of upper GI endoscopy in CKD and end-stage renal disease (ESRD) on regular hemodialysis patients presented to emergency department (ED) with upper GI symptoms. Materials and Methods: Totally 90 CKD patients presented to ED with acute upper GI symptoms to at Tripoli Central Hospital were enrolled in this study. They were 43 females (87.8%) and 47 males (52.2%), age mean (48.9 ± 0.13). They were divided into three groups. Group A: Patients had upper GI endoscopy at presentation and after 3 days. Group B: Patients refused endoscopy at presentation, but they agreed to do it after 3 days of admission. Group C: Patients refused endoscopy at presentation and after 3 days. At ED, patients had clinical assessment, laboratory tests, and abdominal ultrasound before endoscopy. Results: Hematemesis and vomiting were the most common symptoms. Endoscopy findings at presentation in Group A were erosive gastritis in 19 patients (60.3%), erosive esophagitis in 3 patients (10%), superficial esophagitis in 7 patients (23.3%), and duodenal ulcer in 1 patient (3.3%). Repeated endoscopy after 3 days of admission revealed normal mucosal findings in 24 patients (80%) and remarkable improvement of mucosa in the rest of patients. Group B patients (30 patients) had 3 days of proton pump inhibitor therapy at medical ward and/or medical intensive care unit. Endoscopy findings after 3 days of admission revealed normal results in 29 patients (96.7%) and superficial gastritis in 1 patient (3.3%). Conclusion: Urgent endoscopy is not always needed in CKD and ESRD on hemodialysis patients with acute upper GI symptoms who presented to ED. Most of these symptoms can be managed medically, and urgent endoscopy should be deserved to patients with severe GI complications.

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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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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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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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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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Primary pure large-cell neuroendocrine carcinoma (LCNEC) of the ovary is a rare entity which has been reported only through few cases. It is described as an aggressive tumor with the tendency to present at advanced stages and to cause death after a short postoperative time. Until nowadays, there is no standard therapeutic protocol that helps to guide the treatment of this malignancy. In this article, we report two cases of pure LCNEC of the ovary to make physicians aware of this entity and to show its clinical and pathological features in order to put emphasis on its aggressiveness. The first case was a 38-year-old patient diagnosed in 2015. The ovarian LCNEC was classified according to the International Federation of Gynecology and Obstetrics (FIGO) staging classification as FIGO Stage IV and was treated by surgery and chemotherapy. The second case was a 67-year-old patient diagnosed in 2017. The ovarian LCNEC was classified as Stage IIIB and not resectable and was treated by paclitaxel–carboplatin chemotherapy.

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We report a rare case of diclofenac-induced acute pancreatitis in a 52-year-old female who presented to the emergency department with severe abdominal pain after ingesting one tablet of diclofenac sodium 50 mg. The patient had a history of acute pancreatitis after diclofenac ingestion 6 months ago, and there was no history of alcohol intake. Serum amylase and lipase levels were high, and abdominal ultrasonography showed a contracted gallbladder without lithiasis, normal biliary tree, and liver. The patient received conservative management with analgesia, hydration, and fasting, and we resumed back her insulin and amlodipine. She was discharged on the 6^th day of admission after significant clinical and laboratory improvement. During ambulatory follow-up, the patient presented complete resolution of the symptoms and biochemical results. The patient was advised to avoid nonsteroidal anti-inflammatory drugs.

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Pharmaceutical services play a crucial role in any health system. Pharmacists are the main health professionals to ensure that people have access to good and safe medicines and to make certain that these medicines are used rationally. While the role of pharmacists in providing health-care services in Libya remains restricted, the scope of pharmacy practice is vast and encompasses a variety of roles and functions. Most of today's pharmacists' services are oriented toward clinical outcomes using medicines. Therefore, pharmacists are focusing on optimizing the use of medications, promoting health, wellness, and preventing diseases. Pharmaceutical services are currently being tailored to be event driven to fit the current COVID-19 pandemic crisis and to help combat this disease and its consequences. This article discusses different pharmaceutical services that can be provided by pharmacists in all practice settings, for the Libyan healthcare system and to the society in general during COVID-19 crisis.

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We report a case of acute pneumococcal meningitis complicated by rhabdomyolysis and acute renal failure in a 46-year-old Indian man who was brought to the emergency department in an unconscious state after a witnessed generalized tonic–clonic seizure that resolved spontaneously. Lumbar puncture was performed, and cerebrospinal fluid (CSF) analysis revealed white blood cell count of 1500 cells/mm³ (98% neutrophils); glucose level <0.1 mmol/L; and protein level 5.57 g/L. Blood chemistry showed high serum creatinine and creatine phosphokinase (CPK). The patient was sent to the Intensive Care Unit, where he received intravenous antibiotic with early and aggressive hydration, while CSF culture was pending. Two days later, the CSF culture yielded Streptococcus pneumoniae which was sensitive to ceftriaxone and penicillin G. Therefore, ceftriaxone continued for a total of 14 days. The patient maintained good urine output throughout the illness, and his renal parameters improved without dialysis. Eighteen days after admission, he was discharged without fever and with a normal renal function and normal creatine kinase level.

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Background/Aim: Painful diabetic neuropathy (PDN) is a common complication of diabetes. Over recent decades, there has been a rise in the prevalence of diabetes in the Middle East and North Africa (MENA) region. It is suspected that this will be accompanied by an increase in PDN. Epidemiological research on PDN is needed to inform health policy in the MENA region. The aim of this systematic review was to estimate the point prevalence of PDN in countries from the MENA region. Methods: Cross-sectional or longitudinal studies that reported the prevalence of adults with PDN in the MENA region were sought by searching three computerized databases (Medline via web of science, PubMed, and Science Direct). Titles and abstracts were reviewed and screened independently by two researchers (SG and OT). Data extracted were as follows: age, sex, body mass index, sample size, type and duration of diabetes, and point prevalence of PDN. PDN point prevalence was calculated as event rate (i.e., proportion out of 1) and used to produce the overall prevalence in the region using comprehensive meta-analysis software. Results: The searches identified 1657 records. The full texts of 16 records were retrieved following removal of 600 duplicates and exclusions of 1045 abstracts. Five studies were eligible for review following screening of full-text reports. Four of the five reports described surveys of PDN conducted in one country: Saudi Arabia (1 report), Turkey (2 reports), and Algeria (1 report). One report described surveys conducted in Egypt, Lebanon, Jordan, and the Gulf States. The Douleur Neuropathique 4 (DN4) questionnaire was used in seven of the surveys and the Leeds Assessment of Neuropathic Symptoms and Signs pain scale in one survey. The prevalence of PDN was 65.3% for Saudi Arabia, 14% and 23% for Turkey, and 45% for Algeria. The prevalence of PDN was 53.7% in a study that combined estimates from Egypt, Lebanon, Jordan, and Gulf States. Overall, the prevalence of PDN in people with diabetes was 43.2% (95% confidence interval = 30.1%–57.2%, 8 surveys, 7898 participants, 3761 women). Conclusions: The prevalence of PDN in people with diabetes from the MENA region was 43.2% (7898 participants) and higher than estimates from other regions of the world such as the United Kingdom (22%–35%) and the United States of America (11%–25%).

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Background: Vitamin D deficiency is a worldwide health problem and has been associated with religion, faith, caste, education, and socioeconomic status. Scientific evidence indicates that adequate levels of Vitamin D have important implications for the management of health problems. Aim: The aim of this study is to investigate the prevalence of Vitamin D deficiency and associated risk factors among Libyan females. Patients and Methods: This cross-sectional study included 262 female patients presented with nonspecific musculoskeletal and bone pain at Seoul Hospital in Tripoli, Libya. Vitamin D status was measured and risk factors for Vitamin D deficiency were assessed. Results: The mean age ± standard error of mean (SEM) of participants was 40.8 ± 0.9 years (range 18-80 years). In general, approximately 87.7% of the patients (n = 262) have serum Vitamin D concentrations below normal (<30 ng/mL). The mean serum 25-hydroxyvitamin D (25(OH)D) concentration of patients was 13.98 ± 10.2 ng/ml. About 50.8% had 25(OH)D-levels <10 ng/mL which is characterized as severe Vitamin D deficiency, 27.5% had 25(OH)D-levels <20 ng/ml, defined as Vitamin D deficiency. About 9.1% of patients had insufficient Vitamin D, and only 12.6% had sufficient Vitamin D status defined as 25(OH)D-levels ≥30 ng/ml. Conclusions: Our data show that patients with generalized body aches, fatigue, and nonspecific bone pains, all have a significant relationship with Vitamin D deficiency strongly related to risk factors such as inadequate exposure to sunlight, wearing covering clothes, niqab, hijab, low dietary Vitamin D intake, and Vitamin D supplementation.

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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.

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Insulin analogs are preferred by many physicians over human insulins in the management of Type 1 diabetes and in patients with Type 2 diabetes who require insulin. Insulin analogs have a pharmacological profile that is close to the normal physiological action of insulin. There is a notion among some clinicians that insulin analogs offer advantages over human insulins, including better glucose control, less hypoglycemia, and flexibility. A large number of clinical studies, along with systematic reviews, have compared insulin analogs to human insulins in regard to glucose control, rates of hypoglycemia, quality of life, and cost-effectiveness. For Type 1 diabetes, rapid-acting insulin analogs offer better glucose control and less rates of hypoglycemia compared to regular human insulin. Long-acting basal insulins result in less nocturnal hypoglycemia compared to neutral protamine Hagedorn (NPH) insulin but no difference in glucose control in patients with Type 1 diabetes. For patients with Type 2 diabetes, rapid-acting insulins offer no advantage for glucose control or rates of hypoglycemia when compared to regular insulin. There was only a reduction in rates of nocturnal hypoglycemia with no difference in glucose control with the use of basal insulin analogs compared to NPH insulin in Type 2 diabetes. The cost of insulin analogs is considerably higher than human insulins and favorable cost-effectiveness was only demonstrated with rapid-acting insulin analogs in Type 1 diabetes. The available evidence does not support the routine use of insulin analogs over human insulins. There are only few situations where insulin analogs have shown clear benefit over human insulin. In a large percentage of patients cost consideration and lack of better glucose control would favor the use of human insulins.

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Splenic tuberculosis (TB) is usually seen as part of disseminated TB, especially in immunocompromised patients. We report such a case in a 23-year-old immunocompetent male patient who presented with a 10-day history of left-sided abdominal pain and fever. Computed tomography (CT) of the abdomen showed an enlargement of the spleen with multiple hypodense lesions, some of them with septations, the largest measuring 6.9 cm × 5.4 cm, in addition to multiple lymph nodes. Chest X-ray showed left apical fibronodular infiltrate with prominent left hilar region suggestive of enlarge lymph node. Sputum for acid-fast bacilli was positive, and the patient was initiated on 4-drug anti-tuberculous treatment. The diagnosis of splenic TB was retrospectively confirmed based on a complete regression of the splenic lesions on the follow-up CT of the abdomen.

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Background and Aim: Diagnosis of intestinal parasites is confirmed by the recovery of protozoan trophozoites and cysts, helminthes eggs, and larvae in stool samples in the clinical parasitological laboratory. In this study, we look at the prevalence of intestinal parasitic infections (IPIs) in outpatient department and hospitalized patients from different age groups in Tripoli Central Hospital obtained from 2007 to 2009. Materials and Methods: We have used the traditional microscopic technique to diagnose IPIs in all received stool samples during the study period. Results: In total, 18,000 stool samples were examined and it was found that 15.7% of them had at least one parasite. The overall prevalence of intestinal protozoan parasites was as follows: Entamoeba histolytica/Entamoeba dispar 5.1%, Entamoeba coli 10%, Giardia lamblia 8.1%, and Cryptosporidium parvum 1%, while the prevalence of intestinal helminthic parasites in this study was as follows: Enterobius vermicularis 5%, Ascaris lumbricoides 0.5%, and Strongyloides stercoralis 0.01%. Other species of intestinal helminthes are not widely prevalent in Libya. We have found a high prevalence of intestinal parasites, especially the intestinal protozoan parasites. The nonpathogenic protozoan, E. coli, had the highest prevalence rate (10.0%). Conclusion: We conducted the stool sample testing by routine ova and parasite methods, and a concentration technique increases the validity of the estimates.

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The incidence of ductal carcinoma in situ (DCIS) of the breast has greatly increased in countries with breast cancer early detection programs. However, uncertainty remains about its natural history and precise implication of its diagnosis with growing concern in some quarters about possible overdiagnosis and overtreatment. Various molecular techniques have been applied to the investigation of DCIS in an attempt to clarify its biology in relation to invasive breast cancer. The following is a historical tour of some of those molecular studies and the contributions they have made to our understanding of DCIS. It is preceded by a recap of the DCIS conundrum and the uncertainties surrounding its natural history. Peer-reviewed scientific publications on the subject were retrieved by search of PubMed databases. The search was conducted with the following string of keywords: “breast carcinoma in situ genetics,” “breast carcinoma in situ molecular biology,” and “ductal carcinoma in situ molecular method technique.” Reference lists of retrieved articles were scrutinized for additional, relevant publications.

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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.

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Background: Breast cancer is the second most common cancer in the world; the most frequent cancer among women, and leading cause of cancer death in females worldwide. Aim: The aim of the study is to study the pattern and treatment modalities for breast cancer patients who registered in Tripoli University Hospital from 2003 to 2018. Patients and Methods: A retrospective, cross-sectional study was conducted at the Oncology Department of Tripoli University Hospital. A convenience sample of 1000 breast cancer patients from 2003 to 2018 was chosen. Demographic, clinic-pathological characteristics, and treatment modalities data were analyzed by SPSS program version 20. Results: Of 1000 breast cancer patients, there were 984 (98.4%) females and 16 (1.6%) males, mean age was 46.1 ± 11.7 years old, most of them from western region. Majority (64.3%) of female were early age at menarche and 46.2% not breastfed. Positive family history of first degree was 28.8%. The left side presentation was the predominant (60.3%); half of the cases were in Stage II. Invasive ductal carcinoma was diagnosed among 62.5% of the cases and 47% of them were in Grade III. Positive estrogen receptor recorded in 73.8% of cases compared to 69.5% positive progesterone. Furthermore, 76.8% of patients had human epidermal growth factor receptor 2 negative and 78.4% of cases had high Ki-67 level. Regarding management, a combination of surgery, radiation, chemotherapy, and hormonal were provided to 58% of cases, 45.5% of patients who received chemotherapy were treated with FEC regimen. Hormonal therapy was given to 67.7% and tamoxifen is the most drugs used. Conclusions: The frequency is higher among younger age (<50 years), early age at menarche, breastfed less than a year, nearly half presented in late Stage (III, IV), invasive ductal carcinoma is predominant histopathological type, most cases were HER2 negative and high Ki-67 expression. More efforts toward primary prevention and early detection are recommended to reduce locally advanced breast cancer.

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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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