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 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 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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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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Despite being classified as controlled substances in many countries, the use of anabolic androgenic steroids is becoming widespread and no longer limited to bodybuilders or elite athletes. A plausible reason that has fuelled increasing use of such drugs is the increase in modern perception of "ideal" body image and the desire to increase masculinity among younger people. Such drugs are illegally sold through the black market, websites, gyms, body building competitions, teammates, trainers, etc. the health consequences of these medications including their hepatotoxicity are often overlooked. Anabolic androgenic steroid-induced cholestasis may exhibit symptoms and signs indistinguishable from malignancy-induced cholestasis. Patients tend to deny or withhold information regarding the use of these medications. Specific and direct inquiry about the use of these drugs is imperative particularly in young men presenting with cholestatic jaundice. In this paper, we report a 40-year old man with severe cholestasis and marked weight loss (mimicking malignancy) secondary to anabolic androgenic steroid use for bodybuilding. We also performed extensive literature search regarding cholestasis as well other health consequences caused by these medications.

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Megalencephaly, polymicrogyria, polydactyly, and hydrocephalus (MPPH) syndrome has recently been recognized and is a very rare disorder characterized by macrocrania, developmental delay with intellectual disability, and often epilepsy. We report a new case of MPPH syndrome in a 5-year-old Libyan girl with a previously unreported central polydactyly and thoracolumbar myelomeningocele.

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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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