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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

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%).

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Congenital Myelomeningocele and congenital Hydrocephalus are among the most common pediatric neurosurgery diseases in Libya. This paper elucidates the experience of authors in clinical audit of seventy four cases diagnosed as congenital Myelomeningocele and hydrocephalus, in the period of time (Feb 2017 to Dec 2017). Materials and Methods: This was a prospective study of 74 cases whose data were collected as per the pre-prepared data sheet in a single tertiary Institute in Tripoli (Tripoli Medical Center) from February 2017 and December 2017. Results: Management of 74 patients with complete data was analyzed. Of 74 patients, 20 (27%) patients were isolated MMC, 25 (34%) were isolated HCP, and 29 (39%) occurring in association with MMC. From a total of 74 patients, 34 (45%) were male and 40 (54%) were female. Furthermore, 27 (36%) patients delivered as premature infant and 47 (63%) were full term. The method of delivery was by cesarean section in 69 (93%) cases and by normal vaginal delivery in 5 cases (1%). The prenatal diagnosis of MMC and HCP using ultrasound was established in 70 (94%) cases. Head circumference of all cases at the time of delivery was ranged from 33 to 56 cm. The surgical management of all 74 cases after the diagnosis in our neurosurgical department was as follows: Ventriculoperitoneal (VP) shunts inserted in 63 cases (85%). MMC repair was performed in 38 cases (51%). Most patients 55 (74%) were discharged routinely after VP shunt insertion and MMC repair, while 19 (26%) died in hospital. Further, folic acid intake by dose of (0.4 mg) orally was documented in 31 (41%) pregnant women, and 43 (58%) cases were not taken folic acid. The timing of folic acid intake was after the pregnancy was confirmed in all cases. Conclusion: This review demonstrates a single-institute experience and the current challenges in the management of both MMC and HCP in Libya. The Awareness of the mandatory intake of folic in our society is a national call.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Aim: We aimed to validate the Arabic and Tunisian arabic versions of diabetes- specific quality of life (QOL) instrument KINDL-R Diabetes Module for Tunisian children population with type 1 diabetes. Patients and Methods: This a cross-sectionnal study to validate Arabic and Tunisian KINDL QOL instrument that we translate in literary and dialectal Arabic. Both forward and backward translations from the German version of KINDL QOL into Arabic version were performed. Our project received a GPED grant in August 2014. After the face validity of the Arabic version was established, it was then pilot-tested. Finally, the validity and reliability of the final version of the Arabic KINDL questionnaire were evaluated. Results: The KINDL-R Diabetes Module (DM) questionnaire of QOL was given to 212 persons: 108 children (aged 3-17 years) with T1DM and 104 parents. The Cronbach's alpha coefficients of the overall items and the main domains was about 0.7. The mean total score of the KINDL-R DM was 69,56 ± 14,01 in children aged 7-13 years, 59.93±15.17 in children aged 13-17 years and 56.6±9.9 in parents (higher scores indicate better QOL). The parents reported lower diabetes-specific HRQOL than the children themselves (P < 0.01). Emotional score was correlated to environment (P = 0,03). Self-esteem was reported to environment (P = 0,02) and mother's instruction level's (P = 0,014). Conclusions: The KINDL-R Diabetes Module (DM) of QOL in literary and dialectal Arabic have sufficient acceptability, reliability and validity so as to be used for the purposes of a comparative in Tunisian and Arabic populations.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Epileptic patients experience a lot of negative impacts on their lives due to misinterpreting of the disease from the society. Objective: The present study was aimed to assess the parents' knowledge and attitudes toward epilepsy. Methods: The study was conducted in Tripoli city during the period January–July 2015. Community-based cross-sectional study, descriptive in design, was employed. Participants were selected using random sampling technique. Data were collected through a structured pretested questionnaire. Results: Of the 379 study participants, 344 (90.8%) had heard about epilepsy, 54.6% reported that epilepsy is a mental disease, whereas 80.7%, 43.5%, and 70.4% mentioned that it is hereditary, contagious, and is possessed by evil spirits, respectively. Overall, 366 (96.6%) think that epilepsy influence patient self-confidence, 167 (44.1%), 309 (81.5%), and 251 (66.2%) believes that epilepsy is a treatable disease, respectively, by traditional medicine, wearing bracelet, and surgery, but patients will not be entirely cured (214, 56.5%). In this study, negative attitudes were reflected in the parents' belief that people with epilepsy should not have children (66.8%); 351 (92.6%) and 327 (86.3%) keep their children away from people with epilepsy and do not want family member to marry epileptic patient, respectively. Among the respondents, 242 (63.9%) think that people with epilepsy should not be employed with the same jobs as well people, 207 (54.6%), 349 (92.1%), and 337 (88.9%) think, respectively, that people with epilepsy should attend special schools, have specialized center to care their needs and should not get a driving license. Overall, the parents' knowledge and attitude were not gender dependent. Conclusions: Our study demonstrates that most of the participants had lack of knowledge toward epilepsy. The majority of them have negative attitudes and considerable misconceptions. Therefore, the level of knowledge and standpoints needs adequate educational programs.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease. The clinical course of the disease is variable and is characterized by periods of relapses and remissions. The most common disease pattern is a mixture of nonspecific constitutional symptoms accompanied by various internal organ involvements. Peripheral neurologic syndrome and central nervous system manifestations are common in lupus patients but are not always attributable to lupus itself. In the present report, we present a case of transverse myelitis, a rare but serious condition reported in patients with SLE.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Teratomas are the most common germ cell tumors derived from embryonic tissue composed of cells from two or more germ cell layers. These tumors arise in gonads and extragonadal sites such as midline, mediastinum, sacrococcygeal region, and retroperitoneum. Retroperitoneum is an unusual site in adults. Malignant transformation in teratomas is rarely seen only in 1% cases. We present the case of a 57-year-old female patient who presented with abdominal pain and swelling and was diagnosed as adenocarcinoma in a retroperitoneal teratoma. Adenocarcinoma is a rare somatic malignancy arising in a retroperitoneal teratoma. Extensive literature search revealed <20 cases and our patient was unique in presenting at a later age. A review of the current literature is also done.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]