Libyan Journal of Medical Sciences

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Background: The incidence of end-stage renal disease (ESRD) is increasing considerably worldwide; moreover, most of the patients start their therapy by hemodialysis (HD). Arteriovenous fistula (AVF) is the best type of vascular access for use in such therapy, due to its decreased rate of complications, followed by arteriovenous graft (AVG) and finally, central venous catheters, which are associated with, increased mortality and morbidity. In this study, we aim to find out the proportion of the current to initial vascular access used, the timing of creating permanent access, and any complications experienced. Patients and Methods: A cross-sectional study was conducted on two hundred eighteen patients currently on regular hemodialysis program. Their records were reviewed and the data was analyzed for vascular accesses type used at the start of hemodialysis and at the current time, the timing of the creation of permanent access, and the complications occurred. Data collected were statistically analyzed using IBM-SPSS statistics software Inc. Chicago, IL, USA. Results: Out-of-the 218 patients on hemodialysis, 193 patients (88.5%) started hemodialysis via Central venous catheters (CVC), 23 patients (10.5%) had an arterio-venous fistula (AVF), and only two patients (0.9%) used tunneled CVC, while no one has AV-graft. Currently, 82.1% of patients have AVF, 7.8% have chronic CVC, 5.9% have acute CVC and only 4.1% have AV-Graft, Many complications are noted in all types of access with different percentages of occurrence. Conclusion: We concluded that although a high percentage of patients have AVF, still pre-emptive AVF counts very low percentage, serious complications are still happening and we recommend the establishment of joined pre-dialysis clinic with surgeons and psychologists in each dialysis center.

Background/Aims: Infectious diseases are the major public health problem worldwide. The medical services into the Southern Libyan sub-Saharan hospitals do not receive much attention in knowing the infection rates of pathogenic bacteria coming to the hospital, as well as there is not much information available about the hospital infection control application system. This study was performed to evaluate the infectious disease received to Al Kufra teaching hospital and determination the hospital risk factors involved in hospital-acquired infection. Materials and Methods: The screening was performed to investigate the distribution of potential pathogens among 157 samples collected from the four hospital wards including intensive care unit, the pediatric ward, male and female surgical ward from the hospitalizes patients, medical staff and hospital workers, and across different hospital facilities. Results: The bedsores swabs and urine samples showed 100% of infection, followed by sputum, stool, surgical wounds, and cerebrospinal fluid (85.8%, 67%, 62.5%, and 42.9%), respectively. Most of the hospital facilities showed 100% of contamination. The results showed Staphylococcus aureus colonized 40 (77%) of the total nasal swabs, other samples detected Bacillus cereus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis, Escherichia coli 0157. The sensitivity of Gram-positive organisms to the antibiotics showed resistance to Penicillin G (90.1%) and Amoxicillin + Clavulanic acid (82.7%), Methicillin (65.5%) and Vancomycin (65.5%). For Gram-negative organisms, the isolates showed resistance to tetracycline and colistin (62.5%) for each. Conclusion: The bacterial outbreak in the clinical and environmental samples of Al Kufra Teaching Hospital was relatively high. To control bacterial infection and hospital contamination, several instructions need to be carried out to protect the hospital staff and patients from being infected.

Counseling has evolved into an essential component of community pharmacy practice. Patient counseling and addressing drug-related problems are the pharmacist's key activities to ensure the safe and effective use of medicines. There are currently no solid theoretical foundations for research on physician prescribing choices. In fact, doctors' drug prescriptions are a complex phenomenon that are influenced by a number of factors. The majority of current studies in the field of drug prescription use an exploratory approach rather than a theoretical one to describe how doctors make decisions. In Libya, a prescription of medications can easily be obtained from community pharmacies without prescription, resulting in potential drug misuse and health hazard. It was stated previously that there was overprescribing of certain categories of drugs written by Libyan physicians which necessitating further improvement. This review aimed to describe the dispensing practice of prescribed medicines in daily community pharmacy practice in Libya, focusing on counseling, and rational prescription based on the World Health Organization prescribing indicators.

HIV infection and its related opportunistic infections increasing the risk of having HIV-related cholangiopathy, especially those who had low CD4 counts. In this case series, we assessed the findings of endoscopic retrograde cholangiopancreatography and the interventions required in those patients who underwent this procedure at Tripoli Central Hospital between January 2007 and December 2020, comparing them with previous studies conducted in other centers. Our study concluded that common bile duct strictures are more frequent finding than papillary stenosis, and accordingly most of those patients managed by placing common bile duct stent rather than sphincterotomy only.

Background: Hepatitis C virus infection is the most common viral infection in patients on hemodialysis and is a leading cause of chronic liver disease in end-stage renal disease patients. The main aim of this study was to review the outcome of the treatment of HCV in hemodialysis patients with second-generation anti-HCV drugs at Azzawiyah Kidney Hospital. Patients and Methods: Thirty-two hemodialysis patients with proven HCV infection (HCV-polymerase chain reaction-positive) received antiviral treatment for 12 weeks and followed up for 12 months, with liver function tests and repeated HCV-RNA. The primary outcome was the proportion of patients who achieved sustained virological response at 12 weeks posttreatment (SVR-12). Results: 32 patients (32/280, 11.4%) out of the total number of (280) regular hemodialysis patients were proven to have HCV infection, during the period from December 2016 to December 2019. The median age of the study population was 53.5 ± 12 years, and 55% were females. The median duration of dialysis was 9.6 years (range 3–25 years). The causes of chronic kidney disease were diabetes mellitus at 43.7%, hypertension at 25.5%, adult polycystic kidney disease at 12.5%, and chronic glomerulonephritis at 9.3%. Twenty nine (29/32) patients received antiviral treatment with sofosbuvir/daclatasvir (SOF/DLC) and ( 3/32) patients with elbasvir and grazoprevir (ERB/GZR). 96.9% of SOF/DLC achieved SVR 12 and 100% of EBR/GSR by the end of the treatment, only one patient ( 3.1 %) failed to achieve it. No significant side effects were reported for the treatment drugs. Conclusion: This study confirmed that the treatment of hemodialysis patients with chronic hepatitis C infection with second-generation anti-HCV drugs is safe and has elicited a sustained negative virological response.

Lymphomas are a heterogeneous group of malignancies that originate from the neoplastic transformation of lymphocytes. Primary pulmonary non-Hodgkin lymphoma is a rare entity with marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) which is the most common subtype is a low-grade lymphoma accounting for <0.5% of all primary lung neoplasms. The most common presentation is a mass discovered on a chest radiograph in an asymptomatic patient, with symptomatic patients presenting with cough, dyspnea, chest pain, and hemoptysis. On computerized tomography, multiple bilateral lesions are commonly seen in pulmonary MALT lymphoma with consolidation, nodule, and mass being the main morphological patterns. We present two cases diagnosed with marginal zone lymphoma of the lung which is an indolent lymphoma and the most common subtype in the lung.

Online since 31^st January, 2017